Provider Demographics
NPI:1417526278
Name:VINTAGE CARE LLC
Entity Type:Organization
Organization Name:VINTAGE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:720-577-5788
Mailing Address - Street 1:151 SPRING ST
Mailing Address - Street 2:1138
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465
Mailing Address - Country:US
Mailing Address - Phone:720-577-5788
Mailing Address - Fax:
Practice Address - Street 1:151 SPRING ST
Practice Address - Street 2:1138
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465
Practice Address - Country:US
Practice Address - Phone:720-577-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health