Provider Demographics
NPI:1710590005
Name:VINEYARD HEALTHCARE LLC
Entity Type:Organization
Organization Name:VINEYARD HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:UKAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-219-9902
Mailing Address - Street 1:14 MARCY RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2004
Mailing Address - Country:US
Mailing Address - Phone:984-219-9902
Mailing Address - Fax:
Practice Address - Street 1:14 MARCY RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02126-2004
Practice Address - Country:US
Practice Address - Phone:984-219-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health