Provider Demographics
NPI:1609531748
Name:LCA VANTAGE HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:LCA VANTAGE HEALTHCARE CORPORATION
Other - Org Name:LCA VANTAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-631-9504
Mailing Address - Street 1:100 M ST SE STE 600
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3648
Mailing Address - Country:US
Mailing Address - Phone:202-631-9504
Mailing Address - Fax:
Practice Address - Street 1:100 M ST SE STE 600
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3648
Practice Address - Country:US
Practice Address - Phone:202-631-9504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health