| NPI | 1730185232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOREEN RANCOURT Credentialing 802-258-6956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: VT 649) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| 3336I0012X Pharmacy, Institutional Pharmacy | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2023-11-02 |