Provider Demographics
NPI:1043744568
Name:GRACE STREET RECOVERY SERVICES-VERMONT
Entity Type:Organization
Organization Name:GRACE STREET RECOVERY SERVICES-VERMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:802-503-5450
Mailing Address - Street 1:274 SPINNAKER LN
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7783
Mailing Address - Country:US
Mailing Address - Phone:802-503-5450
Mailing Address - Fax:
Practice Address - Street 1:184 KING ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4534
Practice Address - Country:US
Practice Address - Phone:802-503-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty