=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760472971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNINGTON PROJECT INDEPENDENCE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2005
-----------------------------------------------------
Last Update Date | 09/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 HARWOOD HILL RD
-----------------------------------------------------
City | BENNINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05201-9006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-442-8136
-----------------------------------------------------
Fax | 802-447-8291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1504
-----------------------------------------------------
City | BENNINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05201-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-442-8136
-----------------------------------------------------
Fax | 802-447-8291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | LINDA S WICHLAC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 802-442-8136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------