Healthcare Provider Details

I. General information

NPI: 1053910539
Provider Name (Legal Business Name): SEALL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 DEPOT ST
BENNINGTON VT
05201-1816
US

IV. Provider business mailing address

116 BENMONT AVE
BENNINGTON VT
05201-1801
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-4997
  • Fax: 802-442-4997
Mailing address:
  • Phone: 802-442-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NELL MASON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 802-442-4997