Healthcare Provider Details

I. General information

NPI: 1770794323
Provider Name (Legal Business Name): LUND FAMILY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 GLEN RD
BURLINGTON VT
05401-4131
US

IV. Provider business mailing address

PO BOX 4009
BURLINGTON VT
05406-4009
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-7467
  • Fax: 802-864-1619
Mailing address:
  • Phone: 802-864-7467
  • Fax: 802-864-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT ROBINSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 802-864-7467