Provider Demographics
NPI:1215588140
Name:VINE FAITH IN ACTION
Entity Type:Organization
Organization Name:VINE FAITH IN ACTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPISCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-386-5572
Mailing Address - Street 1:421 E HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2635
Mailing Address - Country:US
Mailing Address - Phone:507-387-1666
Mailing Address - Fax:507-387-5775
Practice Address - Street 1:421 E HICKORY ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2635
Practice Address - Country:US
Practice Address - Phone:507-387-1666
Practice Address - Fax:507-387-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA617642900OtherUMPI