Provider Demographics
NPI:1659701571
Name:GIFFORD HEALTH CARE, INC
Entity Type:Organization
Organization Name:GIFFORD HEALTH CARE, INC
Other - Org Name:BETHEL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-728-2211
Mailing Address - Street 1:44 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:802-728-7000
Mailing Address - Fax:802-728-4245
Practice Address - Street 1:1823 VT RTE 107 UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:VT
Practice Address - Zip Code:05032-9324
Practice Address - Country:US
Practice Address - Phone:802-234-9913
Practice Address - Fax:802-234-5507
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIFFORD HEALTH CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-13
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)