1538282140 NPI number — SHARON SYLVESTER

Table of content: (NPI 1538282140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538282140 NPI number — SHARON SYLVESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON SYLVESTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BLUE SPRUCE DEVELOPMENT HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538282140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 BIRCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADFORD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05033-9027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-222-5332
Provider Business Mailing Address Fax Number:
802-222-5332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 BIRCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05033-9027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-222-5332
Provider Business Practice Location Address Fax Number:
802-222-5332
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SYLVESTER
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
802-222-5332

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  0194 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com