NPIMap

Organization Active NPI

State Street Enterprise, LLC

Doing business as Davis Home

  • Assisted Living Facility
  • Windsor, VT
National Provider Identifier
1922130236
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
0021 Issued in VT
Legal business name
STATE STREET ENTERPRISE, LLC
Doing business as
Davis Home
Practice address
45 State St
Windsor, VT 05089-1213
Phone
(802) 674-5300
Fax
(802) 674-5388
NPI assigned
Mar 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Carrie J Patch
Title
Manager
Phone
(802) 674-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 0021 VT Primary

Addresses

Primary practice location

45 State St
Windsor, VT 05089-1213

Mailing address

45 State St
Windsor, VT 05089-1213
Phone (802) 674-5300

Other identifiers 2

IdentifierTypeStateIssuer
047W175MedicaidVT
047W179MedicaidVT

Other names 1

  • Davis Home Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922130236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 STATE ST",
            "city": "WINDSOR",
            "state": "VT",
            "postal_code": "050891213",
            "telephone_number": "802-674-5300",
            "fax_number": "802-674-5388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 STATE ST",
            "city": "WINDSOR",
            "state": "VT",
            "postal_code": "050891213",
            "telephone_number": "802-674-5300",
            "fax_number": "802-674-5388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE STREET ENTERPRISE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PATCH",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "802-674-5300",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "VT",
            "license": "0021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047W175",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047W179",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Windsor, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.