BRATTLEBORO RETREAT - NPI 1164627808 - Psychiatric Hospital in Brattleboro, VT

Q: What is Brattleboro Retreat's NPI number?

The NPI number for Brattleboro Retreat is 1164627808. It was assigned to this organization in the NPPES registry on June 20, 2007.

Q: What is Brattleboro Retreat's specialty?

The primary specialty registered for this NPI is Psychiatric Hospital with taxonomy code 283Q00000X.

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About Brattleboro Retreat NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRATTLEBORO RETREAT (NPI 1164627808) is a healthcare organization registered as a psychiatric hospital in Brattleboro, Vermont and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through March 17, 2028 and lists Jennifer Broussard, Billing Supervisor, as its authorized official.

NPPES Registry Identity

NPI1164627808

Entity TypeOrganization

Primary Taxonomy283Q00000X

Legal Business NameBRATTLEBORO RETREAT

Location AddressANNA MARSH LANEBrattleboro, VT 05301

Mailing AddressPo Box 101Brattleboro, VT 05302-0101 · (802) 257-7785 · Fax (802) 258-3798

Phone(802) 257-7785

Fax(802) 258-3798

Organization SubpartNo

Authorized OfficialJennifer BroussardBilling Supervisor · (802) 258-4392

Enumeration DateJune 20, 2007

Last NPPES UpdateAugust 22, 2020

✔ NPI 1164627808 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatric HospitalHospitals

Taxonomy Code283Q00000X

License✔ Licensed in VT · 649

Definition

An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.

ANNA MARSH LANE, Brattleboro, VT 05301

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Other Identifiers 1

Medicaid1007212VT

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 47D0090903

Brattleboro Retreat · Brattleboro, VT

Active · expires Mar 17, 2028

CLIA Number47D0090903

Laboratory TypeHospital

Certificate Effective DateMarch 18, 2026

Certificate Expiration DateMarch 17, 2028

Laboratory DirectorElizabeth Kilgour

Laboratory Phone(802) 258-6808

Laboratory LocationBrattleboro Retreat1 Anna Marsh Lane, Brattleboro, VT 05302

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRATTLEBORO RETREAT

Clinic/Center (Methadone)