Healthcare Provider Details

I. General information

NPI: 1801364393
Provider Name (Legal Business Name): BEARMT MAPLE LANE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MAPLE LN
BARTON VT
05822-9494
US

IV. Provider business mailing address

60 MAPLE LN
BARTON VT
05822-9494
US

V. Phone/Fax

Practice location:
  • Phone: 802-754-2112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN WYNNE
Title or Position: CFO
Credential:
Phone: 203-904-7462