Basic Information
| Provider Information | |||||||||
| NPI: | 1194749754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RUTLAND COMMUNITY PROGRAMS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78 S MAIN ST | ||||||||
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| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027752381 | ||||||||
| FaxNumber: | 8027477699 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 COURT ST | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027473587 | ||||||||
| FaxNumber: | 8027477689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | POUR | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8027754340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | 047W033 | 05 | VT | MEDICAID |