Provider Demographics
NPI:1770500324
Name:VANTAGE HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:VANTAGE HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIB
Authorized Official - Middle Name:
Authorized Official - Last Name:ANEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-812-8677
Mailing Address - Street 1:117 W CAMDEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9047
Mailing Address - Country:US
Mailing Address - Phone:919-212-9998
Mailing Address - Fax:919-859-8056
Practice Address - Street 1:1129 CORPORATION PKWY
Practice Address - Street 2:SUITE 141
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1381
Practice Address - Country:US
Practice Address - Phone:919-212-9998
Practice Address - Fax:919-859-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2225251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409463Medicaid
NC7704826Medicaid
NC5797290001Medicare NSC