Provider Demographics
NPI:1225199136
Name:EAGLE EYE FARM REHABILITATION CENTER
Entity Type:Organization
Organization Name:EAGLE EYE FARM REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH JANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-525-6939
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:WEST BURKE
Mailing Address - State:VT
Mailing Address - Zip Code:05871-0247
Mailing Address - Country:US
Mailing Address - Phone:802-525-6939
Mailing Address - Fax:
Practice Address - Street 1:3014 ABBOTT HILL ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:VT
Practice Address - Zip Code:05871
Practice Address - Country:US
Practice Address - Phone:802-525-6939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0513320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012106Medicaid