Healthcare Provider Details

I. General information

NPI: 1023298015
Provider Name (Legal Business Name): PINES HEALTH AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 RED VILLAGE RD
LYNDONVILLE VT
05851-9068
US

IV. Provider business mailing address

601 RED VILLAGE RD
LYNDONVILLE VT
05851-9068
US

V. Phone/Fax

Practice location:
  • Phone: 802-626-3361
  • Fax:
Mailing address:
  • Phone: 802-626-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0475044
License Number StateVT

VIII. Authorized Official

Name: MR. TRAVIS BERGERON JR.
Title or Position: ADMINISTRATOR
Credential: DO
Phone: 802-626-3361