MEDICARE: BEARMT PINES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1477021954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEARMT PINES, LLC

Provider Business Mailing Address
First Line	:	601 RED VILLAGE RD
Second Line	:
City	:	LYNDONVILLE
State	:	VT
Zip	:	05851-9068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 RED VILLAGE RD
Second Line	:
City	:	LYNDONVILLE
State	:	VT
Zip	:	05851-9068
Country	:	US
Telephone Number	:	802-626-3361
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOHN WYNNE
Credential	:
Telephone Number	:	203-904-7462

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	11/02/2018

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