The Coon House

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

0043 Issued in VT

Legal business name

THE COON HOUSE

Practice address

74 Route 30 S
Bomoseen, VT 05732

Phone

(802) 468-3216

Fax

(802) 468-3216

NPI assigned

Nov 14, 2006

Reactivated

Aug 15, 2008

Last updated

Aug 15, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shirley D. Sears

Title

Owner

Phone

(802) 468-3216

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218758400000",
    "number": "1619049020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 ROUTE 30 S",
            "city": "BOMOSEEN",
            "state": "VT",
            "postal_code": "05732",
            "telephone_number": "802-468-3216",
            "fax_number": "802-468-3216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 ROUTE 30 S",
            "city": "BOMOSEEN",
            "state": "VT",
            "postal_code": "05732",
            "telephone_number": "802-468-3216",
            "fax_number": "802-468-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COON HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-08-15",
        "deactivation_date": "2008-06-10",
        "reactivation_date": "2008-08-15",
        "status": "A",
        "authorized_official_last_name": "SEARS",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-468-3216"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "VT",
            "license": "0043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Sizemore, MD
• Janine F. Small, LICSW
• Patricia Szabo, LISW
• Erica E Tamblini, LCSW
• Sarah Stork Tatko, PA
• Philip Wagenbach, PA-C
• Rachel Yrsha

• Adult Care Home Facility in Bomoseen, VT
• Providers in Bomoseen, VT by specialty
• Adult Care Home Facility in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.