Provider Demographics
NPI:1285832923
Name:VANTAGE HOME CARE INC.
Entity Type:Organization
Organization Name:VANTAGE HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-238-1048
Mailing Address - Street 1:1275 KASS CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4308
Mailing Address - Country:US
Mailing Address - Phone:352-238-1048
Mailing Address - Fax:
Practice Address - Street 1:1275 KASS CIR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4308
Practice Address - Country:US
Practice Address - Phone:352-238-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107720Medicare ID - Type Unspecified
FL107720Medicare Oscar/Certification