Provider Demographics
NPI:1154775104
Name:MARANATHA NATURAL LIVING LLC
Entity type:Organization
Organization Name:MARANATHA NATURAL LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEACSU KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:802-451-1966
Mailing Address - Street 1:1860 WEATHERHEAD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9821
Mailing Address - Country:US
Mailing Address - Phone:802-451-1966
Mailing Address - Fax:802-738-1066
Practice Address - Street 1:1860 WEATHERHEAD HOLLOW RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-451-1966
Practice Address - Fax:802-738-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0119517261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service