Healthcare Provider Details

I. General information

NPI: 1760472971
Provider Name (Legal Business Name): BENNINGTON PROJECT INDEPENDENCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 HARWOOD HILL RD
BENNINGTON VT
05201-9006
US

IV. Provider business mailing address

PO BOX 1504
BENNINGTON VT
05201-1504
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-8136
  • Fax: 802-447-8291
Mailing address:
  • Phone: 802-442-8136
  • Fax: 802-447-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA S WICHLAC
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 802-442-8136