Provider Demographics
NPI:1518394212
Name:STATE OF VERMONT
Entity Type:Organization
Organization Name:STATE OF VERMONT
Other - Org Name:MIDDLESEX THERAPEUTIC COMMUNITY RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY COMMISSIONER OF MENTAL HLTH
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-828-3824
Mailing Address - Street 1:26 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05609-1105
Mailing Address - Country:US
Mailing Address - Phone:802-828-3824
Mailing Address - Fax:802-828-3823
Practice Address - Street 1:1076 US RTE 2
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:VT
Practice Address - Zip Code:05633-7801
Practice Address - Country:US
Practice Address - Phone:802-828-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0610320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness