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Organization
LIFE INTERVENTION TEAM
Active
Organization
LIFE INTERVENTION TEAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE EDWARDS (EMPLOYEE)
(802) 342-1062
Entity
Organization
Contact information
Practice address
257 S MAIN ST, RUTLAND, VT 05701-4905
(802) 342-1062
(802) 419-9351
Mailing address
257 S MAIN ST, RUTLAND, VT 05701-4905
(802) 342-1062
(802) 419-9351
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
03/06/2023
Last updated
08/22/2023
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