Provider Demographics
NPI:1780913020
Name:TRUE NORTH WILDERNESS PROGRAMS
Entity type:Organization
Organization Name:TRUE NORTH WILDERNESS PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MADHURII
Authorized Official - Middle Name:
Authorized Official - Last Name:BAREFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-583-1144
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-0857
Mailing Address - Country:US
Mailing Address - Phone:802-583-1144
Mailing Address - Fax:802-583-1104
Practice Address - Street 1:5354 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAITSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05673
Practice Address - Country:US
Practice Address - Phone:802-583-1144
Practice Address - Fax:802-583-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTN/A320800000X, 323P00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility