Provider Demographics
NPI:1215478060
Name:UPPER VALLEY HOLISTIC HEALTH LLC
Entity type:Organization
Organization Name:UPPER VALLEY HOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:802-649-1700
Mailing Address - Street 1:160 PALMER CT
Mailing Address - Street 2:STE. 3A
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9061
Mailing Address - Country:US
Mailing Address - Phone:802-649-1700
Mailing Address - Fax:802-649-1704
Practice Address - Street 1:160 PALMER CT
Practice Address - Street 2:STE. 3A
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9061
Practice Address - Country:US
Practice Address - Phone:802-649-1700
Practice Address - Fax:802-649-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0064482261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center