NPIMap

Organization Active NPI

Brattleboro Retreat

  • Psychiatric Hospital
  • Brattleboro, VT
National Provider Identifier
1164627808
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
649 Issued in VT
Legal business name
BRATTLEBORO RETREAT
Practice address
Anna Marsh Lane
Brattleboro, VT 05301
Phone
(802) 257-7785
Fax
(802) 258-3798
NPI assigned
Jun 20, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Broussard
Title
Billing Supervisor
Phone
(802) 258-4392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 649 VT Primary

Addresses

Primary practice location

Anna Marsh Lane
Brattleboro, VT 05301

Mailing address

PO Box 101
Brattleboro, VT 05302-0101
Phone (802) 257-7785

Other identifiers 1

IdentifierTypeStateIssuer
1007212MedicaidVT

National Provider Directory

National Provider Directory
Tax ID family
Dental Dept Brattleboro5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164627808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 101",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053020101",
            "telephone_number": "802-257-7785",
            "fax_number": "802-258-3798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ANNA MARSH LANE",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "05301",
            "telephone_number": "802-257-7785",
            "fax_number": "802-258-3798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRATTLEBORO RETREAT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "802-258-4392"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "VT",
            "license": "649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007212",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brattleboro, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.