Organization
MISTY HEATHER MORN COMMUNITY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FRANCETTA IRENE TICE R.N. (OWNER)
(802) 265-3300
Entity
Organization
Contact information
Practice address
174 BLISSVILLE RD, HYDEVILLE, VT 05750-0176
(802) 265-3300
(802) 265-3300
Mailing address
PO BOX 176, HYDEVILLE, VT 05750-0176
(802) 265-3300
(802) 265-3300
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
0174
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047W125
—
VT
05
—
047W187
—
VT
Enumeration date
05/17/2007
Last updated
08/22/2020
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