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General NPI Number Information
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NPI Number | 1023298015
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Entity Type | Organization
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Legal Business Name | PINES HEALTH AND REHABILITATION CENTER
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 601 RED VILLAGE RD
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City | LYNDONVILLE
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State | VT
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Zip | 05851-9068
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Country | US
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Telephone | 802-626-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 601 RED VILLAGE RD
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City | LYNDONVILLE
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State | VT
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Zip | 05851-9068
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Country | US
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Telephone | 802-626-3361
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. TRAVIS BERGERON JR.
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Credential | DO
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Telephone | 802-626-3361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0475044
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License Number State | VT
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