Basic Information
| Provider Information | |||||||||
| NPI: | 1508890492 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION | ||||||||
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| OtherOrganizationName: | CHCRR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 ALLEN ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004689118 | ||||||||
| FaxNumber: | 8027727973 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 ALLEN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028552083 | ||||||||
| FaxNumber: | 8028552055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 11/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | WHITMER | ||||||||
| AuthorizedOfficialFirstName: | GRANT | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8028552083 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | VT | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 0471815 | 05 | VT | MEDICAID | 03044048 | 05 | NY | MEDICAID | 03044057 | 05 | NY | MEDICAID | 0471814 | 05 | VT | MEDICAID | 0471816 | 05 | VT | MEDICAID | 1010852 | 05 | VT | MEDICAID | 02940256 | 05 | NY | MEDICAID | 03891783 | 05 | NY | MEDICAID | 1010850 | 05 | VT | MEDICAID | 1021223 | 05 | VT | MEDICAID | 0471842 | 05 | VT | MEDICAID | 1010851 | 05 | VT | MEDICAID | 1017651 | 05 | VT | MEDICAID | 0471844 | 05 | VT | MEDICAID | 1019786 | 05 | VT | MEDICAID | 1025859 | 05 | VT | MEDICAID | 03891774 | 05 | NY | MEDICAID | 03891792 | 05 | NY | MEDICAID | 0471836 | 05 | VT | MEDICAID | 1013682 | 05 | VT | MEDICAID |