Healthcare Provider Details

I. General information

NPI: 1992793491
Provider Name (Legal Business Name): ST. JOHNSBURY HEALTH AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 HOSPITAL DRIVE
ST JOHNSBURY VT
05819-9239
US

IV. Provider business mailing address

538 PRESTON AVE SUITE 270
MERIDEN CT
06450-4851
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-8757
  • Fax: 802-748-6503
Mailing address:
  • Phone: 203-608-6100
  • Fax: 203-639-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0270000333
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateVT

VIII. Authorized Official

Name: MS. CAROLE M SCILLIA
Title or Position: LLC MANAGER
Credential:
Phone: 203-608-6100