Provider Demographics
NPI:1578658753
Name:VERMONT FAMILY NETWORK
Entity Type:Organization
Organization Name:VERMONT FAMILY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-876-5315
Mailing Address - Street 1:600 BLAIR PARK
Mailing Address - Street 2:STE 240
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7549
Mailing Address - Country:US
Mailing Address - Phone:802-876-5315
Mailing Address - Fax:802-876-6291
Practice Address - Street 1:600 BLAIR PARK ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7549
Practice Address - Country:US
Practice Address - Phone:802-764-5290
Practice Address - Fax:802-764-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006372Medicaid