Healthcare Provider Details

I. General information

NPI: 1750295879
Provider Name (Legal Business Name): GREEN MOUNTAIN RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LAKESIDE AVE STE 225
BURLINGTON VT
05401-5098
US

IV. Provider business mailing address

128 LAKESIDE AVE STE 225
BURLINGTON VT
05401-5098
US

V. Phone/Fax

Practice location:
  • Phone: 802-272-4982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DANIEL CUTLER
Title or Position: OWNER
Credential:
Phone: 802-272-4982