Healthcare Provider Details

I. General information

NPI: 1932303823
Provider Name (Legal Business Name): SPRUCE MOUNTAIN INN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 TOWNE AVE
PLAINFIELD VT
05667-0153
US

IV. Provider business mailing address

PO BOX 153 155 TOWNE AVE
PLAINFIELD VT
05667-0153
US

V. Phone/Fax

Practice location:
  • Phone: 802-454-8353
  • Fax: 802-454-1008
Mailing address:
  • Phone: 802-454-8353
  • Fax: 802-454-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number0527
License Number StateVT

VIII. Authorized Official

Name: CANDACE BEARDSLEY
Title or Position: DIRECTOR
Credential: LICSW
Phone: 802-454-8353