Provider Demographics
NPI:1598306516
Name:VESTA, INC.
Entity Type:Organization
Organization Name:VESTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUK-CHING
Authorized Official - Middle Name:
Authorized Official - Last Name:AU-YEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-296-1379
Mailing Address - Street 1:9301 ANNAPOLIS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3125
Mailing Address - Country:US
Mailing Address - Phone:240-296-1379
Mailing Address - Fax:301-459-9110
Practice Address - Street 1:9301 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3115
Practice Address - Country:US
Practice Address - Phone:240-296-1379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260991601Medicaid