Basic Information
| Provider Information | |||||||||
| NPI: | 1093843328 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARLOS G OTIS HEALTH CARE CENTER INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | GRACE COTTAGE SWING BED | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 216 | ||||||||
| Address2: | |||||||||
| City: | TOWNSHEND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 053530216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023653601 | ||||||||
| FaxNumber: | 8023657031 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 GRAFTON RD | ||||||||
| Address2: | |||||||||
| City: | TOWNSHEND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023657357 | ||||||||
| FaxNumber: | 8023657031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8023653601 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 686 | VT | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.