Healthcare Provider Details

I. General information

NPI: 1407934334
Provider Name (Legal Business Name): STARR FARM PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 STARR FARM RD
BURLINGTON VT
05401-1323
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-6717
  • Fax: 802-658-6432
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number27-0000331
License Number StateVT

VIII. Authorized Official

Name: MS. MARILYN A WEAVER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7563