Healthcare Provider Details

I. General information

NPI: 1457348443
Provider Name (Legal Business Name): WINDSOR HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 COUNTY RD
WINDSOR VT
05089-9000
US

IV. Provider business mailing address

289 COUNTY RD
WINDSOR VT
05089-9000
US

V. Phone/Fax

Practice location:
  • Phone: 802-674-7227
  • Fax: 802-674-7028
Mailing address:
  • Phone: 802-674-7227
  • Fax: 802-674-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number475024
License Number StateVT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0475024
Identifier TypeMEDICAID
Identifier StateVT
Identifier Issuer

VIII. Authorized Official

Name: SHERRY BELLEMER
Title or Position: DEPT MANAGER
Credential:
Phone: 802-674-7334