Healthcare Provider Details

I. General information

NPI: 1508890492
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 ALLEN ST SUITE 101
RUTLAND VT
05701-4570
US

IV. Provider business mailing address

71 ALLEN ST STE 101
RUTLAND VT
05701-4570
US

V. Phone/Fax

Practice location:
  • Phone: 802-855-2083
  • Fax: 802-855-2055
Mailing address:
  • Phone: 800-468-9118
  • Fax: 802-772-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GRANT L WHITMER
Title or Position: EXEC DIRECTOR
Credential:
Phone: 802-855-2083