Provider Demographics
NPI:1912078924
Name:THE FAMILY PLACE
Entity type:Organization
Organization Name:THE FAMILY PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLOOMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-649-3268
Mailing Address - Street 1:319 US ROUTE 5 S
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-9431
Mailing Address - Country:US
Mailing Address - Phone:802-649-3268
Mailing Address - Fax:802-649-3270
Practice Address - Street 1:319 US ROUTE 5 S
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9431
Practice Address - Country:US
Practice Address - Phone:802-649-3268
Practice Address - Fax:802-649-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005625Medicaid