| Organization Name: | WINTERGREEN RESIDENTIAL CARE, LLC |
| NPI Number: | 1023323037 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY JENSEN (OWNER/MEMBER) |
| Mailing Address: | 3 Union St Brandon |
| State: | VT US |
| Postal Code: | 057331127 |
| Phone Number: | 8024654101 |
| Fax Number: | |
| NPI Enumeration Date: | 08/13/2010 |
| NPI Last Update Date: | 08/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |