Provider Demographics
NPI:1477712107
Name:VINTAGE HEALTH CARE SERVICES, INC
Entity Type:Organization
Organization Name:VINTAGE HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:AKANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-368-3499
Mailing Address - Street 1:20300 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1011
Mailing Address - Country:US
Mailing Address - Phone:773-368-3499
Mailing Address - Fax:630-260-1035
Practice Address - Street 1:20300 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1011
Practice Address - Country:US
Practice Address - Phone:773-368-3499
Practice Address - Fax:630-260-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010816251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148018Medicare Oscar/Certification