Provider Demographics
NPI:1871039479
Name:VINTAGE VINETOURS LLC
Entity Type:Organization
Organization Name:VINTAGE VINETOURS LLC
Other - Org Name:MENDO ACCESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HOUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-485-4879
Mailing Address - Street 1:14361 HWY 128
Mailing Address - Street 2:BOX 236
Mailing Address - City:BOONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95415
Mailing Address - Country:US
Mailing Address - Phone:707-895-2641
Mailing Address - Fax:
Practice Address - Street 1:14361 HWY 128
Practice Address - Street 2:BOX 236
Practice Address - City:BOONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95415
Practice Address - Country:US
Practice Address - Phone:707-895-2641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC6528142343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)