Provider Demographics
NPI:1891120770
Name:LAMOILLE RESTORATIVE CENTER
Entity type:Organization
Organization Name:LAMOILLE RESTORATIVE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-888-5871
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-0148
Mailing Address - Country:US
Mailing Address - Phone:802-888-5871
Mailing Address - Fax:802-888-5400
Practice Address - Street 1:221 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655
Practice Address - Country:US
Practice Address - Phone:802-888-5871
Practice Address - Fax:802-888-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management