Healthcare Provider Details

I. General information

NPI: 1073898987
Provider Name (Legal Business Name): MERRY MEADOW FARM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 LOWER PLN
BRADFORD VT
05033-8936
US

IV. Provider business mailing address

2122 LOWER PLN
BRADFORD VT
05033-8936
US

V. Phone/Fax

Practice location:
  • Phone: 802-222-9393
  • Fax: 802-222-5422
Mailing address:
  • Phone: 802-222-9393
  • Fax: 802-222-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number0520
License Number StateVT

VIII. Authorized Official

Name: STEVEN THOMAS WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 802-222-9393