Provider Demographics
NPI:1760688972
Name:VINCENT HEALTHCARE, INC.
Entity Type:Organization
Organization Name:VINCENT HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:WHITMAN
Authorized Official - Last Name:MANGINO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:215-233-5058
Mailing Address - Street 1:851 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:ERDENHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:19038-1846
Mailing Address - Country:US
Mailing Address - Phone:215-233-5058
Mailing Address - Fax:215-233-1282
Practice Address - Street 1:851 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:ERDENHEIM
Practice Address - State:PA
Practice Address - Zip Code:19038-1846
Practice Address - Country:US
Practice Address - Phone:215-233-5058
Practice Address - Fax:215-233-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP001552H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS60732Medicare UPIN
PA059874Medicare ID - Type Unspecified