Provider Demographics
NPI:1427020585
Name:UNION HOUSE NURSING HOME, INC
Entity type:Organization
Organization Name:UNION HOUSE NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-525-6600
Mailing Address - Street 1:3086 GLOVER ST
Mailing Address - Street 2:
Mailing Address - City:GLOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05839-9701
Mailing Address - Country:US
Mailing Address - Phone:802-525-6600
Mailing Address - Fax:
Practice Address - Street 1:3086 GLOVER ST
Practice Address - Street 2:
Practice Address - City:GLOVER
Practice Address - State:VT
Practice Address - Zip Code:05839-9701
Practice Address - Country:US
Practice Address - Phone:802-525-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2025-08-27
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
VT0475036Medicaid
VT0475036Medicaid