Provider Demographics
NPI:1235574476
Name:VNA & HOSPICE OF THE SOUTHWEST REGION, INC
Entity Type:Organization
Organization Name:VNA & HOSPICE OF THE SOUTHWEST REGION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-770-1515
Mailing Address - Street 1:7 ALBERT CREE DR
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4601
Mailing Address - Country:US
Mailing Address - Phone:802-775-0568
Mailing Address - Fax:802-775-2304
Practice Address - Street 1:3 GENERAL WING RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4758
Practice Address - Country:US
Practice Address - Phone:802-775-0568
Practice Address - Fax:802-775-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT477007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0477007Medicaid
VT0477007Medicaid