Healthcare Provider Details

I. General information

NPI: 1083832851
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTERS OF BURLINGTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 RIVERSIDE AVE
BURLINGTON VT
05401-1601
US

IV. Provider business mailing address

617 RIVERSIDE AVE
BURLINGTON VT
05401-1601
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-6309
  • Fax: 802-860-4325
Mailing address:
  • Phone: 802-864-6309
  • Fax: 802-860-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID SIMMONS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 802-864-6309