Healthcare Provider Details

I. General information

NPI: 1912078924
Provider Name (Legal Business Name): THE FAMILY PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 US ROUTE 5 S
NORWICH VT
05055-9431
US

IV. Provider business mailing address

319 US ROUTE 5 S
NORWICH VT
05055-9431
US

V. Phone/Fax

Practice location:
  • Phone: 802-649-3268
  • Fax: 802-649-3270
Mailing address:
  • Phone: 802-649-3268
  • Fax: 802-649-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY B BLOOMFIELD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 802-649-3268