Basic Information
Provider Information
NPI: 1790100246
EntityType: 2
ReplacementNPI:  
OrganizationName: RUTLAND HEALTH AND REHAB CENTER
LastName:  
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Credential:  
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Mailing Information
Address1: 45 MCADAM RD
Address2:  
City: WESTMORELAND
State: NH
PostalCode: 034674306
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 46 NICHOLS ST
Address2:  
City: RUTLAND
State: VT
PostalCode: 057013275
CountryCode: US
TelephoneNumber: 8027752941
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/20/2014
LastUpdateDate: 02/20/2014
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ProviderGenderCode:  
AuthorizedOfficialLastName: BAZAN
AuthorizedOfficialFirstName: DAWN
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AuthorizedOfficialTitleorPosition: REHAB DIRECTOR
AuthorizedOfficialTelephone: 8027752941
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
305R00000X073.0000200VTY Managed Care OrganizationsPreferred Provider Organization 

No ID Information.


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