Provider Demographics
NPI:1902895287
Name:VERNON ADVENT CHRISTIAN HOME, INC.
Entity Type:Organization
Organization Name:VERNON ADVENT CHRISTIAN HOME, INC.
Other - Org Name:VERNON GREEN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:M.
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-254-6041
Mailing Address - Street 1:61 GREENWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:VT
Mailing Address - Zip Code:05354-9474
Mailing Address - Country:US
Mailing Address - Phone:802-254-6041
Mailing Address - Fax:802-257-5362
Practice Address - Street 1:61 GREENWAY DRIVE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:VT
Practice Address - Zip Code:05354-9474
Practice Address - Country:US
Practice Address - Phone:802-254-6041
Practice Address - Fax:802-257-5362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0475008Medicaid
VT475008Medicare ID - Type Unspecified