Provider Demographics
NPI:1215023759
Name:CENTRAL VERMONT MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CENTRAL VERMONT MEDICAL CENTER INC
Other - Org Name:WOODRIDGE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHEYENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-371-4109
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0550
Mailing Address - Country:US
Mailing Address - Phone:802-371-4700
Mailing Address - Fax:802-371-4720
Practice Address - Street 1:142 WOODRIDGE DR.
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9165
Practice Address - Country:US
Practice Address - Phone:802-371-4700
Practice Address - Fax:802-371-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT270000165314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0007208OtherMEDICAID PHARMACY
VT0475045Medicaid
5624220002OtherDMERC
5624220002OtherDMERC