Organization
HEALTH CARE & REHABILITATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDMUND H MOORE (CFO)
(802) 463-3294
Entity
Organization
Contact information
Practice address
1 HOSPITAL CT, SUITE 410, BELLOWS FALLS, VT 05101-1489
(802) 463-3294
(802) 463-1206
Mailing address
1 HOSPITAL CT, SUITE 410, BELLOWS FALLS, VT 05101-1489
(802) 463-3294
(802) 463-1206
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6060010
—
VT
Enumeration date
04/19/2007
Last updated
08/22/2020
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