Provider Demographics
NPI:1043818677
Name:INNER FIRE, INC
Entity Type:Organization
Organization Name:INNER FIRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTREACH AND MARKETING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-451-0125
Mailing Address - Street 1:26 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:VT
Mailing Address - Zip Code:05345-9793
Mailing Address - Country:US
Mailing Address - Phone:802-221-8051
Mailing Address - Fax:802-221-8051
Practice Address - Street 1:26 PARKER RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:VT
Practice Address - Zip Code:05345-9793
Practice Address - Country:US
Practice Address - Phone:802-221-8051
Practice Address - Fax:802-221-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility