Provider Demographics
NPI:1336682616
Name:VINTAGE POINT HOME CARE LLC
Entity Type:Organization
Organization Name:VINTAGE POINT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:914-523-6670
Mailing Address - Street 1:2105 NEREID AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1133
Mailing Address - Country:US
Mailing Address - Phone:914-523-6670
Mailing Address - Fax:
Practice Address - Street 1:2105 NEREID AVE APT 2F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1133
Practice Address - Country:US
Practice Address - Phone:914-523-6670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296219305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization