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Organization
KINGDOM REHAB CENTER, LLC
Active
Organization
KINGDOM REHAB CENTER, LLC
Active
Other names
Maple Lane Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS BERGERON (DIRECTOR OF OPERATIONS)
(802) 754-8575
Entity
Organization
Contact information
Practice address
60 MAPLE LN, BARTON, VT 05822-9494
(802) 754-8575
(802) 754-2113
Mailing address
60 MAPLE LN, BARTON, VT 05822-9494
(802) 754-8575
(802) 754-2113
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0475042
—
VT
Enumeration date
02/03/2006
Last updated
08/27/2025
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