1780545400 NPI number — BENNINGTON-RUTLAND SUPERVISORY UNION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780545400 NPI number — BENNINGTON-RUTLAND SUPERVISORY UNION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENNINGTON-RUTLAND SUPERVISORY UNION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780545400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6378 VT ROUTE 7A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNDERLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-362-2452
Provider Business Mailing Address Fax Number:
802-362-2455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6378 VT ROUTE 7A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNDERLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-362-2452
Provider Business Practice Location Address Fax Number:
802-362-2455
Provider Enumeration Date:
11/21/2025

Additional Information

Authorized Official

Authorized Official Last Name:
KONDRACKI
Authorized Official First Name:
WREN
Authorized Official Middle Name:
DULLAHAN
Authorized Official Title or Position:
ADMIN ASSISTANT (MEDICAID/HHB)
Authorized Official Telephone Number:
802-362-2452

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1004528 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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