Provider Demographics
NPI:1093917916
Name:VANTAGE HEALRTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:VANTAGE HEALRTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIB
Authorized Official - Middle Name:
Authorized Official - Last Name:ANEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-858-8444
Mailing Address - Street 1:117 W CAMDEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9047
Mailing Address - Country:US
Mailing Address - Phone:919-858-8444
Mailing Address - Fax:
Practice Address - Street 1:117 W CAMDEN FOREST DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9047
Practice Address - Country:US
Practice Address - Phone:919-858-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2225251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600903Medicaid
NC3409463Medicaid