1770500324 NPI number — VANTAGE HEALTHCARE SERVICES, INC

Table of content: (NPI 1770500324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770500324 NPI number — VANTAGE HEALTHCARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANTAGE HEALTHCARE SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770500324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 W CAMDEN FOREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27518-9047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-212-9998
Provider Business Mailing Address Fax Number:
919-859-8056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1129 CORPORATION PKWY
Provider Second Line Business Practice Location Address:
SUITE 141
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27610-1381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-212-9998
Provider Business Practice Location Address Fax Number:
919-859-8056
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANEN
Authorized Official First Name:
CHIB
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
919-812-8677

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC2225 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3409463 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7704826 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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