Provider Demographics
NPI:1316901770
Name:WAKE ROBIN CORPORATION
Entity type:Organization
Organization Name:WAKE ROBIN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHYPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-264-5150
Mailing Address - Street 1:200 WAKE ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7569
Mailing Address - Country:US
Mailing Address - Phone:802-264-5100
Mailing Address - Fax:802-985-8452
Practice Address - Street 1:200 WAKE ROBIN DR
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7569
Practice Address - Country:US
Practice Address - Phone:802-264-5100
Practice Address - Fax:802-985-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility