Provider Demographics
NPI:1073943999
Name:GIFFORD HEALTH CARE, INC
Entity Type:Organization
Organization Name:GIFFORD HEALTH CARE, INC
Other - Org Name:TWIN RIVER HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-728-2211
Mailing Address - Street 1:44 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:802-728-7000
Mailing Address - Fax:802-728-4245
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7056
Practice Address - Country:US
Practice Address - Phone:802-296-7370
Practice Address - Fax:802-296-7174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIFFORD HEALTH CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-13
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)