Provider Demographics
NPI:1518020577
Name:PROJECT INDEPENDENCE
Entity Type:Organization
Organization Name:PROJECT INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-476-3630
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:EAST BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05649-0417
Mailing Address - Country:US
Mailing Address - Phone:802-476-3630
Mailing Address - Fax:
Practice Address - Street 1:420 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5533
Practice Address - Country:US
Practice Address - Phone:802-476-3630
Practice Address - Fax:802-479-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT=========Medicaid