Shady Grove Farm And Wellness Center
Early Intervention Provider Agency in Peru, NY. Organization (NPI-2).
NPI number1326388331
StatusActive
Last updated in NPPESFeb 28, 2013
Details
- NPI
- 1326388331
- Entity type
- Organization (NPI-2)
- Legal business name
- Shady Grove Farm And Wellness Center
- Organization subpart
- No
- Enumeration date
- Feb 28, 2013
- Last updated
- Feb 28, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 252Y00000X | Early Intervention Provider Agency | 011853-1 | NY | Yes |
Practice location
844 State Route 22bPeru, NY 12972-5421
Phone 518-569-3440
Mailing address
844 State Route 22bPeru, NY 12972-5421
Phone 518-569-3440
Authorized official
Karen M Bouchard-Braun
President
5185693440
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