Provider Demographics
NPI:1629505730
Name:VINE HOMECARE
Entity Type:Organization
Organization Name:VINE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EJIOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-532-5592
Mailing Address - Street 1:153 ANDOVER ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1455
Mailing Address - Country:US
Mailing Address - Phone:978-532-5592
Mailing Address - Fax:978-539-8419
Practice Address - Street 1:153 ANDOVER ST STE 104
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1455
Practice Address - Country:US
Practice Address - Phone:978-532-5592
Practice Address - Fax:978-539-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health