Healthcare Provider Details

I. General information

NPI: 1285971721
Provider Name (Legal Business Name): VERMONT PERMANENCY INITIATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 FAIRVIEW ST
BENNINGTON VT
05201-9239
US

IV. Provider business mailing address

PO BOX 325
ORFORD NH
03777-0325
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-1557
  • Fax: 802-447-3234
Mailing address:
  • Phone: 603-353-9102
  • Fax: 603-353-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMMY OLSEN
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 603-353-9102