Healthcare Provider Details

I. General information

NPI: 1700873718
Provider Name (Legal Business Name): VILLA REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FOREST HILL DRIVE
ST. ALBANS VT
05478
US

IV. Provider business mailing address

7 FOREST HILL DRIVE
ST. ALBANS VT
05478
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-3498
  • Fax: 802-524-3071
Mailing address:
  • Phone: 802-524-3498
  • Fax: 203-639-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number027000156
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateVT

VIII. Authorized Official

Name: MRS. COLEEN C KOHAUT
Title or Position: OWNER
Credential: NHA
Phone: 802-752-1600