Provider Demographics
NPI:1982897203
Name:MOUNTAIN VALLEY HEALTH COUNCIL INC
Entity type:Organization
Organization Name:MOUNTAIN VALLEY HEALTH COUNCIL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LITCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-824-6901
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:VT
Mailing Address - Zip Code:05148-0310
Mailing Address - Country:US
Mailing Address - Phone:802-824-6901
Mailing Address - Fax:802-824-3602
Practice Address - Street 1:38 RTE 11
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:VT
Practice Address - Zip Code:05148-0310
Practice Address - Country:US
Practice Address - Phone:802-824-6901
Practice Address - Fax:802-824-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT473829Medicaid