Provider Demographics
NPI:1326588773
Name:VANTAGE HEALTH SYSTEM
Entity Type:Organization
Organization Name:VANTAGE HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOISITS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:201-214-4661
Mailing Address - Street 1:93 W PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2611
Mailing Address - Country:US
Mailing Address - Phone:201-567-0500
Mailing Address - Fax:
Practice Address - Street 1:315 LOCUST ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4003
Practice Address - Country:US
Practice Address - Phone:201-907-0726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-05
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness