Healthcare Provider Details

I. General information

NPI: 1598954539
Provider Name (Legal Business Name): FLYING HIGH FARM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LEOMINSTER RD
LUNENBURG MA
01462-2013
US

IV. Provider business mailing address

615 LEOMINSTER RD
LUNENBURG MA
01462-2013
US

V. Phone/Fax

Practice location:
  • Phone: 978-582-7103
  • Fax: 775-582-7103
Mailing address:
  • Phone: 978-582-7103
  • Fax: 775-582-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111274
License Number StateMA

VIII. Authorized Official

Name: MRS. CHRISTINE RANDLE
Title or Position: PRESIDENT
Credential: LICSW
Phone: 978-582-7103