Provider Demographics
NPI:1790254340
Name:VINE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:VINE HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:704-701-4948
Mailing Address - Street 1:2632 LANCE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-2297
Mailing Address - Country:US
Mailing Address - Phone:704-701-4948
Mailing Address - Fax:
Practice Address - Street 1:2632 LANCE RIDGE WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-2297
Practice Address - Country:US
Practice Address - Phone:704-701-4948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health