Provider Demographics
NPI:1932108222
Name:HELEN PORTER NURSING HOME INC
Entity Type:Organization
Organization Name:HELEN PORTER NURSING HOME INC
Other - Org Name:HELEN PORTER HEALTHCARE & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-5607
Mailing Address - Street 1:30 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8422
Mailing Address - Country:US
Mailing Address - Phone:802-388-4001
Mailing Address - Fax:802-388-3474
Practice Address - Street 1:30 PORTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8422
Practice Address - Country:US
Practice Address - Phone:802-388-4001
Practice Address - Fax:802-388-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT270000163314000000X
VT385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00595804Medicaid
VT047R022Medicaid
VT0475017Medicaid
VT047R022Medicaid