1316904360 NPI number — MAPLE LEAF FARM ASSOCIATES, INC.

Table of content: (NPI 1316904360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316904360 NPI number — MAPLE LEAF FARM ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAPLE LEAF FARM ASSOCIATES, 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:
Provider Other Organization Name Type Code:
6
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:
1316904360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
786 COLLEGE PARKWAY
Provider Second Line Business Mailing Address:
MAPLE LEAF TREATMENT CENTER
Provider Business Mailing Address City Name:
COLCHESTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-899-2911
Provider Business Mailing Address Fax Number:
802-899-2327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 MAPLE LEAF FARM RD
Provider Second Line Business Practice Location Address:
MAPLE LEAF TREATMENT CENTER
Provider Business Practice Location Address City Name:
UNDERHILL
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-899-2911
Provider Business Practice Location Address Fax Number:
802-899-2327
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IACUZZI
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO & EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
802-899-2911

Provider Taxonomy Codes

  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , 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)





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