Provider Demographics
NPI:1538293451
Name:RUTLAND COMMUNITY PROGRAMS, INC
Entity Type:Organization
Organization Name:RUTLAND COMMUNITY PROGRAMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:POUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-775-4340
Mailing Address - Street 1:78 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4530
Mailing Address - Country:US
Mailing Address - Phone:802-775-2381
Mailing Address - Fax:802-747-7699
Practice Address - Street 1:6 COURT ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4032
Practice Address - Country:US
Practice Address - Phone:802-747-3587
Practice Address - Fax:802-747-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W149Medicaid