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General NPI Number Information
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NPI Number | 1568434629
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Entity Type | Organization
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Legal Business Name | KINGDOM REHAB CENTER, LLC
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 60 MAPLE LN
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City | BARTON
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State | VT
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Zip | 05822-9494
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Country | US
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Telephone | 802-754-8575
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Fax | 802-754-2113
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Provider Business Mailing Address
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Address Line | 60 MAPLE LN
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City | BARTON
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State | VT
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Zip | 05822-9494
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Country | US
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Telephone | 802-754-8575
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Fax | 802-754-2113
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. TRAVIS BERGERON
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Credential |
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Telephone | 802-754-8575
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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 |
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License Number State | VT
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