1164417283 NPI number — RUTLAND MENTAL HEALTH SERVICES, INC.

Table of content: (NPI 1164417283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164417283 NPI number — RUTLAND MENTAL HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUTLAND MENTAL HEALTH SERVICES, INC.
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:
1164417283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
78 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-4530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-775-8224
Provider Business Mailing Address Fax Number:
802-747-7699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
78 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-4530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-775-2381
Provider Business Practice Location Address Fax Number:
802-747-7699
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEALD
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
COORDINATOR AR
Authorized Official Telephone Number:
802-775-8224

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00800315 . This is a "BCBS QUITTING TIME" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1002799 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007264 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00800892 . This is a "BCBS PARTIAL" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1001099 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007919 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5551A . This is a "MVP PHD AND MASTERS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 00018644 . This is a "BCBS EVERGREEN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1009761 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00006063 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1009760 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5551 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 5551B . This is a "MVP MD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0006063 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047M016 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006424 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 303598 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com