Provider Demographics
NPI:1538282140
Name:SHARON SYLVESTER
Entity Type:Organization
Organization Name:SHARON SYLVESTER
Other - Org Name:BLUE SPRUCE DEVELOPMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-222-5332
Mailing Address - Street 1:70 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-9027
Mailing Address - Country:US
Mailing Address - Phone:802-222-5332
Mailing Address - Fax:802-222-5332
Practice Address - Street 1:70 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-9027
Practice Address - Country:US
Practice Address - Phone:802-222-5332
Practice Address - Fax:802-222-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0194311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W095Medicare ID - Type UnspecifiedACCS
VT047W064Medicare ID - Type UnspecifiedERC