Organization
NORTHEAST KINGDOM HUMAN SERVICES INC DS WAIVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC GRIMS (CHIEF EXECUTIVE OFFICER)
(802) 334-6744
Entity
Organization
Contact information
Practice address
154 DUCHESS AVE, NEWPORT, VT 05855-5516
(802) 334-6744
(802) 334-7340
Mailing address
PO BOX 724, NEWPORT, VT 05855-0724
(802) 334-6744
(802) 334-7340
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6040016
—
VT
Enumeration date
03/14/2007
Last updated
08/22/2020
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