Provider Demographics
NPI:1669656062
Name:VESTA, INC.
Entity Type:Organization
Organization Name:VESTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:240-296-6099
Mailing Address - Street 1:9301 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3115
Mailing Address - Country:US
Mailing Address - Phone:240-296-5848
Mailing Address - Fax:
Practice Address - Street 1:22 INDUSTRIAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2791
Practice Address - Country:US
Practice Address - Phone:240-296-6030
Practice Address - Fax:301-638-9992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VESTA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-20
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260991608Medicaid
MD949LOtherMEDICARE