Provider Demographics
NPI:1316165129
Name:LITTLE RIVERS HEALTH CARE, INC.
Entity type:Organization
Organization Name:LITTLE RIVERS HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-222-9276
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05051-0008
Mailing Address - Country:US
Mailing Address - Phone:802-222-9276
Mailing Address - Fax:
Practice Address - Street 1:437 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033
Practice Address - Country:US
Practice Address - Phone:802-222-9276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012614Medicaid
VT1012615Medicaid
VT1012615Medicaid
471825Medicare Oscar/Certification
NHRE8821Medicare PIN