Provider Demographics
NPI:1952517823
Name:BRATTLEBORO CROSSINGS LLC
Entity Type:Organization
Organization Name:BRATTLEBORO CROSSINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERBLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-263-3808
Mailing Address - Street 1:187 OAK GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-257-0307
Mailing Address - Fax:802-257-0309
Practice Address - Street 1:187 OAK GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-257-0307
Practice Address - Fax:802-257-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT475023Medicare Oscar/Certification