Healthcare Provider Details

I. General information

NPI: 1356434831
Provider Name (Legal Business Name): EAGLE EYE FARM REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 ABBOTT HILL ROAD
NEWARK VT
05871
US

IV. Provider business mailing address

PO BOX 247
WEST BURKE VT
05871
US

V. Phone/Fax

Practice location:
  • Phone: 802-723-9800
  • Fax: 802-723-9800
Mailing address:
  • Phone: 802-723-9800
  • Fax: 802-723-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateVT

VIII. Authorized Official

Name: MS. SARAH JANE ROHAN ALEXANDER
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 802-723-9800