Provider Demographics
NPI:1912502212
Name:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-468-9118
Mailing Address - Street 1:71 ALLEN ST STE 402
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:800-468-9118
Mailing Address - Fax:
Practice Address - Street 1:69 ALLEN ST STE 7
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:800-468-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty