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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