Health Care & Rehabilitation Services of SE VT Inc.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Springfield, VT
NPI 1184401929 · NPPES record last updated Sep 14, 2023
Key facts
- NPI
- 1184401929
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- HEALTH CARE & REHABILITATION SERVICES OF SE VT INC.
- Practice address
- 390 River Street
Springfield, VT 05156-2226 - Phone
- (802) 886-4500
- Fax
- (802) 886-4520
- NPI assigned
- Sep 14, 2023
- Organization subpart
- No
Authorized official
- Name
- Edmund H Moore IV
- Title
- Cfo
- Phone
- (802) 886-4567
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 21
Practitioners 1
-
Eric K Jacobson, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040819001433 | VT | Part B Supplier - Clinic/Group Practice | 4183698830 |
Receives reassigned benefits from 39 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bellows Falls, VT; Brattleboro, VT; Hartford, VT; Newfane, VT; Springfield, VT; White River Junction, VT; Windsor, VT |
National Provider Directory
- Tax ID family
- HCRS
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
390 River Street
Springfield, VT 05156-2226
Mailing address
390 River Street
Springfield, VT 05156-2226
Phone (802) 886-4500
Other providers in Springfield, VT
- April R Harmer
- A'Shalanique Harris
- Matthew Hart
- Cassandra Hattam
- Sharon Haumann
- Health Care & Rehabilitation Services of SE VT Inc.
- Health Care & Rehabilitation Services of SE VT Inc.
- Health Care and Rehabilitation Services of SE VT
- Health Care and Rehabilitation Services of SE VT
- Health Care and Rehabilitation Services of Southeastern Vermont, Inc.
All providers in Springfield, VT · Mental Health Clinic/Center (Including Community Mental Health Center) in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.