Healthcare Provider Details

I. General information

NPI: 1932232527
Provider Name (Legal Business Name): RUTLAND MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 S MAIN ST
RUTLAND VT
05701-4530
US

IV. Provider business mailing address

78 S MAIN ST
RUTLAND VT
05701-4530
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-8224
  • Fax: 802-747-7699
Mailing address:
  • Phone: 802-775-8224
  • Fax: 802-747-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MORALES
Title or Position: BILLING MANAGER
Credential:
Phone: 802-770-5417