Basic Information
| Provider Information | |||||||||
| NPI: | 1235261009 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RUTLAND MENTAL HEALTH SERVICES | ||||||||
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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: | 8027758224 | ||||||||
| FaxNumber: | 8027477699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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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 | 251S00000X | X | Agencies | Community/Behavioral Health | 261QD1600X | X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | 261QM0850X | X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 6040018 | 05 | VT | MEDICAID | 1007353 | 05 | VT | MEDICAID | 6030007 | 05 | VT | MEDICAID |