Basic Information
| Provider Information | |||||||||
| NPI: | 1164417283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RUTLAND MENTAL HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027758224 | ||||||||
| FaxNumber: | 8027477699 | ||||||||
| Practice Location | |||||||||
| Address1: | 78 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027752381 | ||||||||
| FaxNumber: | 8027477699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | HEALD | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COORDINATOR AR | ||||||||
| AuthorizedOfficialTelephone: | 8027758224 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315P00000X | N | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded | 251S00000X | N | Agencies | Community/Behavioral Health | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 261QD1600X | N | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | 103K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 00800315 | 01 | VT | BCBS QUITTING TIME | OTHER | 1002799 | 05 | VT | MEDICAID | 1007264 | 05 | VT | MEDICAID | 00800892 | 01 | VT | BCBS PARTIAL | OTHER | 1001099 | 05 | VT | MEDICAID | 1007919 | 05 | VT | MEDICAID | 5551A | 01 | VT | MVP PHD AND MASTERS | OTHER | 00018644 | 01 | VT | BCBS EVERGREEN | OTHER | 1009761 | 05 | VT | MEDICAID | 00006063 | 01 | VT | BCBS | OTHER | 1009760 | 05 | VT | MEDICAID | 5551 | 01 | VT | MVP | OTHER | 5551B | 01 | VT | MVP MD | OTHER | 0006063 | 05 | VT | MEDICAID | 047M016 | 05 | VT | MEDICAID | 1006424 | 05 | VT | MEDICAID | 303598 | 01 | VT | VALUE OPTIONS | OTHER |