Provider Demographics
NPI:1518366384
Name:VINEYARD COMMUNITY CENTER
Entity Type:Organization
Organization Name:VINEYARD COMMUNITY CENTER
Other - Org Name:VINEYARD FREE HEALTH CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF VINEYARD COMM
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-259-5501
Mailing Address - Street 1:6000 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8984
Mailing Address - Country:US
Mailing Address - Phone:614-890-0000
Mailing Address - Fax:614-890-5056
Practice Address - Street 1:6000 COOPER RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8984
Practice Address - Country:US
Practice Address - Phone:614-890-0000
Practice Address - Fax:614-890-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable