Provider Demographics
NPI:1790100246
Name:RUTLAND HEALTH AND REHAB CENTER
Entity Type:Organization
Organization Name:RUTLAND HEALTH AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-775-2941
Mailing Address - Street 1:45 MCADAM RD
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:NH
Mailing Address - Zip Code:03467-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3275
Practice Address - Country:US
Practice Address - Phone:802-775-2941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073.0000200305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization