Basic Information
| Provider Information | |||||||||
| NPI: | 1902008485 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHEAST WASHINGTON COUNTY COMMUNITY HEALTH INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | CABOT HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 320 | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056670320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024548336 | ||||||||
| FaxNumber: | 8024548339 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 COMMON ROAD | ||||||||
| Address2: | |||||||||
| City: | CABOT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056470999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025632118 | ||||||||
| FaxNumber: | 8024548339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MACRITCHIE | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8024548336 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.