Healthcare Provider Details

I. General information

NPI: 1366832230
Provider Name (Legal Business Name): GIFFORD RETIREMENT COMMUNITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 RT 66
RANDOLPH VT
05060-1318
US

IV. Provider business mailing address

44 S MAIN ST PO BOX 2000
RANDOLPH VT
05060-1381
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-2125
  • Fax: 802-728-2143
Mailing address:
  • Phone: 802-728-7000
  • Fax: 802-728-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY C HEBERT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 802-728-2356