Provider Demographics
NPI:1033549159
Name:VANGAURD HOME HEALTHCARE
Entity Type:Organization
Organization Name:VANGAURD HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:APNP-BC
Authorized Official - Phone:414-216-4516
Mailing Address - Street 1:9310 N 107TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-1121
Mailing Address - Country:US
Mailing Address - Phone:414-216-4516
Mailing Address - Fax:414-527-1063
Practice Address - Street 1:9310 N 107TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-1121
Practice Address - Country:US
Practice Address - Phone:414-216-4516
Practice Address - Fax:414-527-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health