Healthcare Provider Details

I. General information

NPI: 1215023759
Provider Name (Legal Business Name): CENTRAL VERMONT MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 WOODRIDGE DR.
BERLIN VT
05602-9165
US

IV. Provider business mailing address

PO BOX 550
BARRE VT
05641-0550
US

V. Phone/Fax

Practice location:
  • Phone: 802-371-4700
  • Fax: 802-371-4720
Mailing address:
  • Phone: 802-371-4700
  • Fax: 802-371-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number270000165
License Number StateVT

VIII. Authorized Official

Name: CHEYENNE HOLLAND
Title or Position: CFO
Credential:
Phone: 802-371-4109