Healthcare Provider Details

I. General information

NPI: 1780913020
Provider Name (Legal Business Name): TRUE NORTH WILDERNESS PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 MAIN ST
WAITSFIELD VT
05673
US

IV. Provider business mailing address

PO BOX 857
WAITSFIELD VT
05673-0857
US

V. Phone/Fax

Practice location:
  • Phone: 802-583-1144
  • Fax: 802-583-1104
Mailing address:
  • Phone: 802-583-1144
  • Fax: 802-583-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberN/A
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberN/A
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberN/A
License Number StateVT

VIII. Authorized Official

Name: MADHURII BAREFOOT
Title or Position: FOUNDER, CLINICAL DIRECTOR
Credential:
Phone: 802-583-1144