Healthcare Provider Details

I. General information

NPI: 1043818677
Provider Name (Legal Business Name): INNER FIRE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 PARKER RD
BROOKLINE VT
05345-9793
US

IV. Provider business mailing address

26 PARKER RD
BROOKLINE VT
05345-9793
US

V. Phone/Fax

Practice location:
  • Phone: 802-221-8051
  • Fax: 802-221-8051
Mailing address:
  • Phone: 802-221-8051
  • Fax: 802-221-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOYCE REILLY
Title or Position: OUTREACH AND MARKETING COORDINATOR
Credential:
Phone: 802-451-0125