Provider Demographics
NPI:1750567806
Name:THE MANE HOUSE
Entity type:Organization
Organization Name:THE MANE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-860-1099
Mailing Address - Street 1:3097 WILLISTON RD
Mailing Address - Street 2:THE MANE HOUSE
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-860-1099
Mailing Address - Fax:802-651-4944
Practice Address - Street 1:3097 WILLISTON RD
Practice Address - Street 2:THE MANE HOUSE
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6044
Practice Address - Country:US
Practice Address - Phone:802-860-1099
Practice Address - Fax:802-651-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies