Provider Demographics
NPI:1871629022
Name:NORTHEAST KINGDOM HOMECARE, INC.
Entity type:Organization
Organization Name:NORTHEAST KINGDOM HOMECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-334-7604
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:100 SECOND STREET
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-0250
Mailing Address - Country:US
Mailing Address - Phone:802-334-7604
Mailing Address - Fax:802-334-1347
Practice Address - Street 1:100 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-2185
Practice Address - Country:US
Practice Address - Phone:802-334-7604
Practice Address - Fax:802-334-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0602261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W270OtherDAY HEALTH REHAB DERVICE
VT047W272OtherADULT DAY SERVICE