Provider Demographics
| NPI: | 1164417283 |
|---|---|
| Name: | RUTLAND MENTAL HEALTH SERVICES, INC. |
| Entity type: | Organization |
| Organization Name: | RUTLAND MENTAL HEALTH SERVICES, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | COORDINATOR AR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LINDA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | HEALD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 802-775-8224 |
| 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: | 802-775-8224 |
| Mailing Address - Fax: | 802-747-7699 |
| Practice Address - Street 1: | 78 S MAIN ST |
| Practice Address - Street 2: | |
| Practice Address - City: | RUTLAND |
| Practice Address - State: | VT |
| Practice Address - Zip Code: | 05701-4530 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 802-775-2381 |
| Practice Address - Fax: | 802-747-7699 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-09-14 |
| Last Update Date: | 2023-11-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| VT | 00800315 | Other | BCBS QUITTING TIME |
| VT | 1002799 | Medicaid | |
| VT | 1007264 | Medicaid | |
| VT | 00800892 | Other | BCBS PARTIAL |
| VT | 1001099 | Medicaid | |
| VT | 1007919 | Medicaid | |
| VT | 5551A | Other | MVP PHD AND MASTERS |
| VT | 00018644 | Other | BCBS EVERGREEN |
| VT | 1009761 | Medicaid | |
| VT | 00006063 | Other | BCBS |
| VT | 1009760 | Medicaid | |
| VT | 5551 | Other | MVP |
| VT | 5551B | Other | MVP MD |
| VT | 0006063 | Medicaid | |
| VT | 047M016 | Medicaid | |
| VT | 1006424 | Medicaid | |
| VT | 303598 | Other | VALUE OPTIONS |
| VT | VN0701 | Medicare ID - Type Unspecified | MEDICARE LICSW |
| VT | 1009761 | Medicaid | |
| VT | 1001099 | Medicaid |
