Provider Demographics
NPI:1760863054
Name:VANTAGE AGING
Entity Type:Organization
Organization Name:VANTAGE AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HRDLICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-253-4597
Mailing Address - Street 1:2279 ROMIG RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3823
Mailing Address - Country:US
Mailing Address - Phone:330-253-4597
Mailing Address - Fax:
Practice Address - Street 1:2279 ROMIG RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320
Practice Address - Country:US
Practice Address - Phone:330-253-4597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2876848Medicaid
OH2876848Medicaid