Provider Demographics
NPI:1588895502
Name:WHITE RIVER JUNCTION VETERANS HOSPITAL
Entity type:Organization
Organization Name:WHITE RIVER JUNCTION VETERANS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL SCIENCE PROGRAM SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CHERICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:505-870-1855
Mailing Address - Street 1:4401 S COULTER ST APT 1913
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 N MAIN STREET WHITE RIVER JUNCTION VT 05009
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1437286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT=========Medicaid