Organization
WINDOVER HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD L JACOBS (PRESIDENT)
(802) 728-3802
Entity
Organization
Contact information
Practice address
451 VT ROUTE 66, RANDOLPH, VT 05060-9387
(802) 728-3802
Mailing address
451 VT ROUTE 66, RANDOLPH, VT 05060-9387
(802) 728-3802
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
0109
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
047W047
ERC PROVIDER #
VT
01
—
047W101
ACCS PROVIDER#
VT
Enumeration date
03/20/2007
Last updated
08/22/2020
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