Milldale Farm Center for Wellness PLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MILLDALE FARM CENTER FOR WELLNESS PLC

Practice address

1461 Blood Brook Rd
Fairlee, VT 05045-9847

Phone

(802) 299-1467

NPI assigned

Jan 19, 2023

Last updated

Jan 19, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Wesley WolterNPI 1417420290

Title

Owner

Phone

(802) 299-1467

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wesley Wolter, MS,MA

  • Addiction (Substance Use Disorder) Counselor
  • Fairlee, VT
  • NPI 1417420290
  NPD Authorized official

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

{
    "created_epoch": "1674086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1508571043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1461 BLOOD BROOK RD",
            "city": "FAIRLEE",
            "state": "VT",
            "postal_code": "050459847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 BLOOD BROOK RD",
            "city": "FAIRLEE",
            "state": "VT",
            "postal_code": "050459847",
            "telephone_number": "802-299-1467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLDALE FARM CENTER FOR WELLNESS PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "WOLTER",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-299-1467"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417420290",
            "state": "VT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "milldalefarmwellness.com",
            "affiliation": "N",
            "address_1": "1461 Blood Brook Rd",
            "city": "Fairlee",
            "state": "VT",
            "country_code": "US",
            "postal_code": "050459847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Margaret Anne Burden, RN
• Deborah I Hodge (Valley View Home for the Retired)
• Brenda L Egbert
• Gregory Scott Graham, MS
• Little Rivers Health Care, Inc.
• Carol Elissa Owen, LICSW
• Bonny Payne, DC
• Samantha Petrone, RDH, BSDH
• Stefan Piscitelli
• Kyla Suarez

• Mental Health Clinic/Center (Including Community Mental Health Center) in Fairlee, VT
• Providers in Fairlee, VT by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.