Provider Demographics
NPI:1356434831
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:ROHAN
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-723-9800
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
Mailing Address - Country:US
Mailing Address - Phone:802-723-9800
Mailing Address - Fax:802-723-9800
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:802-723-9800
Practice Address - Fax:802-723-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004774Medicaid
VT1012106Medicaid