COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION

Provider Demographics

• NPI: 1508890492
• Name: COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
• Entity Type: Organization
• Organization Name: COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
• Other - Org Name: CHCRR
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: EXEC DIRECTOR
• Authorized Official - First Name: GRANT
• Authorized Official - Middle Name: L
• Authorized Official - Last Name: WHITMER
• Authorized Official - Phone: 802-855-2083
• Mailing Address - Street 1: 71 ALLEN ST
• Mailing Address - Street 2: STE 101
• Mailing Address - City: RUTLAND
• Mailing Address - State: VT
• Mailing Address - Zip Code: 05701-4570
• Mailing Address - Country: US
• Mailing Address - Phone: 800-468-9118
• Mailing Address - Fax: 802-772-7973
• Practice Address - Street 1: 71 ALLEN ST
• Practice Address - Street 2: SUITE 101
• Practice Address - City: RUTLAND
• Practice Address - State: VT
• Practice Address - Zip Code: 05701-4570
• Practice Address - Country: US
• Practice Address - Phone: 802-855-2083
• Practice Address - Fax: 802-855-2055
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-10
• Last Update Date: 2016-11-10

Provider Licenses

State	License ID	Taxonomies
VT		261QF0400X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	261QF0400X	Ambulatory Health Care Facilities	Clinic/Center	Federally Qualified Health Center (FQHC)

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VT	0471815	Medicaid
NY	03044048	Medicaid
NY	03044057	Medicaid
VT	0471814	Medicaid
VT	0471816	Medicaid
VT	1010852	Medicaid
NY	02940256	Medicaid
NY	03891783	Medicaid
VT	1010850	Medicaid
VT	1021223	Medicaid
VT	0471842	Medicaid
VT	1010851	Medicaid
VT	1017651	Medicaid
VT	0471844	Medicaid
VT	1019786	Medicaid
VT	1025859	Medicaid
NY	03891774	Medicaid
NY	03891792	Medicaid
VT	0471836	Medicaid
VT	1013682	Medicaid
VT	VN357202	Medicare PIN
VT	VN3572	Medicare PIN
VT	47-1836	Medicare PIN
VT	47-1844	Medicare PIN
VT	1010852	Medicaid
NY	03891774	Medicaid
VT	0471815	Medicaid
VT	1017651	Medicaid
NY	03891783	Medicaid
VT	VN3573	Medicare PIN
VT	47-1842	Medicare PIN