Organization Active NPI

Maranatha Natural Living LLC

  • Health Service Clinic/Center
  • Guilford, VT
National Provider Identifier
1154775104
Registry record updated Aug 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
101.0119517 Issued in VT
Legal business name
MARANATHA NATURAL LIVING LLC
Practice address
1860 Weatherhead Hollow Rd
Guilford, VT 05301
Phone
(802) 451-1966
Fax
(802) 738-1066
NPI assigned
Apr 15, 2016
Last updated
Aug 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Gabriella Neacsu Katz, FNP-BCNPI 1326413899
Title
Owner
Phone
(802) 451-1966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 101.0119517 VT Primary

Addresses

Primary practice location

1860 Weatherhead Hollow Rd
Guilford, VT 05301

Mailing address

1860 Weatherhead Hollow Rd
Guilford, VT 05301-9821
Phone (802) 451-1966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180626002687 VT Part B Supplier - Clinic/Group Practice 5193070555 Receives reassigned benefits from 1 practitioner
Practice locations: Guilford, VT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
47D2241140Maranatha Natural Living, LLC1860 Weatherhead Hollow Rd, Guilford, VT 05301Certificate of waiverOct 25, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1154775104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 WEATHERHEAD HOLLOW RD",
            "city": "GUILFORD",
            "state": "VT",
            "postal_code": "053019821",
            "telephone_number": "802-451-1966",
            "fax_number": "802-738-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 WEATHERHEAD HOLLOW RD",
            "city": "GUILFORD",
            "state": "VT",
            "postal_code": "05301",
            "telephone_number": "802-451-1966",
            "fax_number": "802-738-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARANATHA NATURAL LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-15",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "NEACSU KATZ",
        "authorized_official_first_name": "GABRIELLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-451-1966",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "VT",
            "license": "101.0119517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Guilford, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.