Provider Demographics
NPI:1700873718
Name:VILLA REHAB CENTER
Entity Type:Organization
Organization Name:VILLA REHAB CENTER
Other - Org Name:REDSTONE VILLA NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOHAUT
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:802-752-1600
Mailing Address - Street 1:7 FOREST HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478
Mailing Address - Country:US
Mailing Address - Phone:802-524-3498
Mailing Address - Fax:203-639-3574
Practice Address - Street 1:7 FOREST HILL DRIVE
Practice Address - Street 2:
Practice Address - City:ST. ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-524-3498
Practice Address - Fax:802-524-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT027000156314000000X
VT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0475055Medicaid
475055AMedicare Oscar/Certification
VT475055AMedicare Oscar/Certification