Kingdom Rehab Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

KINGDOM REHAB CENTER, LLC

Doing business as

Maple Lane Nursing Home

Practice address

60 Maple LN
Barton, VT 05822-9494

Phone

(802) 754-8575

Fax

(802) 754-2113

NPI assigned

Feb 3, 2006

Last updated

Aug 27, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Travis Bergeron

Title

Director of Operations

Phone

(802) 754-8575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Maple Lane Nursing Home Doing business as

Medicare fee-for-service enrollment

Enrolled in VT2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568434629. Details of each certification follow.

• CCN 475042A Skilled nursing facility · Details

Skilled nursing facility certification: CCN 475042A

Legal name

KINGDOM REHAB CENTER, LLC

Doing business as

MAPLE LANE NURSING HOME

Organization structure

LLCProprietary

Enrollment address

60 Maple Lane
Barton, VT 05822-9494

Nursing home name

MAPLE LANE NURSING HOME

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Kingdom Kare Rehabilitation Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Kingdom Kare Rehabilitation Center

  dba Maple Lane Nursing Home

  • Skilled Nursing Facility
  • Barton, VT
  • NPI 1518156603
  NPD tax ID

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Maria D Fatigati, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Barton, VT
  • NPI 1235193111

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Pine Knoll Nursing Home, Inc

  dba Pines Rehabilitation & Health Center

  • Skilled Nursing Facility
  • Lyndonville, VT
  • NPI 1225000383

  Francis E Cheney Jr Estate

  CMS ownership
• Union House Nursing Home, Inc

  • Skilled Nursing Facility
  • Glover, VT
  • NPI 1427020585

  Francis E Cheney Jr Estate

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Janet L Patterson, N.P.

  • Adult Health Nurse Practitioner
  • St Johnsbury, VT
  • NPI 1992755219
  Medicare reassignment NPD
• Kathleen Anne Guilmain, APRN GNP-BC

  • Gerontology Nurse Practitioner
  • North Haverhill, NH
  • NPI 1093000648

  VT

  Medicare reassignment NPD
• Maria D Fatigati, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Barton, VT
  • NPI 1235193111
  NPD (past)

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756252800000",
    "number": "1568434629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MAPLE LN",
            "city": "BARTON",
            "state": "VT",
            "postal_code": "058229494",
            "telephone_number": "802-754-8575",
            "fax_number": "802-754-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MAPLE LN",
            "city": "BARTON",
            "state": "VT",
            "postal_code": "058229494",
            "telephone_number": "802-754-8575",
            "fax_number": "802-754-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM REHAB CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-03",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A",
        "authorized_official_last_name": "BERGERON",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "802-754-8575",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0475042",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Lane Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa M Higgins, M.ED, NCC, LCMHC
• Katy Kuchta, LLC
• Amy D Kerr, PT
• Mary King, RN, BSN, IBCLC
• Kingdom Kare Rehabilitation Center (Maple Lane Nursing Home)
• Virgil John Kovachich II, MA,LADC,LCMHC
• KPH Healthcare Services, Inc. (Kinney Drugs #105)
• Katy Kuchta, MASTERS
• Monica Menard, MS, CCC-SLP
• Gail Carol Middlebrook, M.A. LCMHC LADC

• Skilled Nursing Facility in Barton, VT
• Providers in Barton, VT by specialty
• Skilled Nursing Facility in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.