Organization
MARANATHA MISSION HOME NETWORK, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN SHEPERD LADC (PRESIDENT)
(802) 848-9455
Entity
Organization
Contact information
Practice address
2580 COUNTY HIGHWAY 11, HARTWICK, NY 13348-2101
(802) 848-9455
Mailing address
PO BOX 97, RICHFORD, VT 05476-0097
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
151.0126020
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14143916
CAQH
VT
Enumeration date
04/16/2018
Last updated
04/16/2018
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