Provider Demographics
NPI:1598954539
Name:FLYING HIGH FARM, INC
Entity Type:Organization
Organization Name:FLYING HIGH FARM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-582-7103
Mailing Address - Street 1:615 LEOMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-2013
Mailing Address - Country:US
Mailing Address - Phone:978-582-7103
Mailing Address - Fax:775-582-7103
Practice Address - Street 1:615 LEOMINSTER RD
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-2013
Practice Address - Country:US
Practice Address - Phone:978-582-7103
Practice Address - Fax:775-582-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1112741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1081760OtherFALLON
MAP10415OtherBCBS