# NORTHEAST KINGDOM COUNCIL ON AGING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104272343
- **Authorized official:** MS. DEBORAH ROUSSEAU ROUSSEAU (DIRECTOR OF CASE MANAGEMENT)
- **Authorized official phone:** (802) 748-5182

## Contact information

- **Practice address:** 481 SUMMER ST STE 101, SAINT JOHNSBURY, VT 05819-2103
- **Practice address phone:** (802) 748-5182
- **Practice address fax:** (802) 748-6622
- **Mailing address:** 481 SUMMER ST STE 101, SAINT JOHNSBURY, VT 05819-2103
- **Mailing address phone:** (802) 748-5182
- **Mailing address fax:** (802) 748-6622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | VT | Yes |

## Other

- **Enumeration date:** 05/06/2016
- **Last updated:** 05/06/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 047W003 | — | VT |