NPIMap

Organization Active NPI

47 Main Street Corporation

Doing business as Fortyseven Main Street, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Castleton, VT
National Provider Identifier
1134465784
Registry record updated Dec 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
47 MAIN STREET CORPORATION
Doing business as
Fortyseven Main Street, Inc
Practice address
706 Main Street
Castleton, VT 05735-0038
Phone
(800) 287-5325
Fax
(802) 468-5152
NPI assigned
Dec 28, 2012
Last updated
Dec 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Willem Leenman, MHSA
Title
Director
Phone
(802) 468-5325

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

706 Main Street
Castleton, VT 05735-0038

Mailing address

PO Box 38
706 Main Street
Castleton, VT 05735-0038
Phone (800) 287-5325

Other names 1

  • Fortyseven Main Street, Inc Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356652800000",
    "number": "1134465784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38",
            "address_2": "706 MAIN STREET",
            "city": "CASTLETON",
            "state": "VT",
            "postal_code": "057350038",
            "telephone_number": "800-287-5325",
            "fax_number": "802-468-5152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 MAIN STREET",
            "city": "CASTLETON",
            "state": "VT",
            "postal_code": "057350038",
            "telephone_number": "800-287-5325",
            "fax_number": "802-468-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "47 MAIN STREET CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-28",
        "last_updated": "2012-12-28",
        "status": "A",
        "authorized_official_last_name": "LEENMAN",
        "authorized_official_first_name": "WILLEM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "802-468-5325",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fortyseven Main Street, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Castleton, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.