47 Main Street Corporation

NPI #1134465784 in Castleton, Vermont

Provider Information

NPI Number: 1134465784
Entity Type: Organization
Organization Name: 47 Main Street Corporation
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Dec 28, 2012
Last Updated: Dec 28, 2012

Practice Location

Address: 706 MAIN STREET
City: Castleton
State: Vermont
ZIP Code: 05735-0038
Phone: (800) 287-5325

Authorized Official

Name: WILLEM LEENMAN, MHSA
Title: DIRECTOR
Phone: (802) 468-5325

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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