Provider Demographics
NPI:1083601975
Name:FRANKLIN COUNTY REHAB CENTER, LLC
Entity Type:Organization
Organization Name:FRANKLIN COUNTY REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:802-752-1600
Mailing Address - Street 1:110 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-6299
Mailing Address - Country:US
Mailing Address - Phone:802-752-1600
Mailing Address - Fax:802-752-1699
Practice Address - Street 1:110 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-6299
Practice Address - Country:US
Practice Address - Phone:802-752-1600
Practice Address - Fax:802-752-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT475047Medicare ID - Type Unspecified
VT5162840001Medicare NSC