Provider Demographics
NPI:1518156603
Name:KINGDOM KARE REHABILITATION CENTER
Entity Type:Organization
Organization Name:KINGDOM KARE REHABILITATION CENTER
Other - Org Name:MAPLE LANE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:III
Authorized Official - Credentials:NHA
Authorized Official - Phone:802-754-8575
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:VT
Mailing Address - Zip Code:05822-0500
Mailing Address - Country:US
Mailing Address - Phone:802-754-8575
Mailing Address - Fax:
Practice Address - Street 1:MAIL STOP # 500
Practice Address - Street 2:MAPLE HILL ROAD
Practice Address - City:BARTON
Practice Address - State:VT
Practice Address - Zip Code:05822-0500
Practice Address - Country:US
Practice Address - Phone:802-754-8575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0475044314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1568434629Medicaid