Provider Demographics
NPI:1437364759
Name:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
Other - Org Name:COMMUNITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-468-5641
Mailing Address - Street 1:275 ROUTE 30 N
Mailing Address - Street 2:
Mailing Address - City:BOMOSEEN
Mailing Address - State:VT
Mailing Address - Zip Code:05732-9647
Mailing Address - Country:US
Mailing Address - Phone:802-468-5641
Mailing Address - Fax:802-468-2923
Practice Address - Street 1:69 ALLEN ST STE 10
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-774-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty