=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043159460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERMONT VILLAS SENIOR LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2026
-----------------------------------------------------
Last Update Date | 03/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 162 JACKSON AVE
-----------------------------------------------------
City | RUTLAND
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05701-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-522-6737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 CHAMPLAIN ST
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05733-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | AMY RUSSELL
-----------------------------------------------------
Credential | MHA, BSN, RN, LNHA
-----------------------------------------------------
Telephone | 518-441-4442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311Z00000X
-----------------------------------------------------
Taxonomy Name | Custodial Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------