1770794323 NPI number — LUND FAMILY CENTER, INC.

Table of content: (NPI 1770794323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770794323 NPI number — LUND FAMILY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUND FAMILY CENTER, INC.
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:
LUND RESIDENTIAL AND COMMUNITY TREATMENT PROGRAMS
Provider Other Organization Name Type Code:
5
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:
1770794323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05406-4009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-864-7467
Provider Business Mailing Address Fax Number:
802-864-1619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 GLEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-864-7467
Provider Business Practice Location Address Fax Number:
802-864-1619
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
802-864-7467

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 322D00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1012820 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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