Provider Demographics
NPI:1316440456
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:802-222-4637
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:802-222-4637
Mailing Address - Fax:802-222-5674
Practice Address - Street 1:2420 ROUTE 302
Practice Address - Street 2:
Practice Address - City:WELLS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05081-9750
Practice Address - Country:US
Practice Address - Phone:802-757-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE RIVERS HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-15
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-01245861041C0700X
VT042-0007871207Q00000X
VT089-00919851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1316165129Medicaid