Organization
CHAMPLAIN VALLEY BRACE AND LIMB, L.L.C.
Active
Parent organization
ACTIVSTYLE HOLDING COMPANY
Other names
ActivStyle
Organization subpart
Yes
Provider details
NPI number
Legal business name
ACTIVSTYLE HOLDING COMPANY
Authorized official
STEPHEN GRIGGS (CEO)
(407) 206-0040
Entity
Organization
Contact information
Practice address
528 ESSEX RD, SUITE 201, WILLISTON, VT 05495-7555
(518) 907-0225
(518) 561-5335
Mailing address
1701 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2638
(800) 651-6223
(866) 896-7171
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013711
—
VT
Enumeration date
12/31/2007
Last updated
04/28/2021
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