Provider Demographics
NPI:1922877018
Name:VINE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:VINE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAYODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-489-2700
Mailing Address - Street 1:8955 EDMONSTON RD UNIT A-C
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1006
Mailing Address - Country:US
Mailing Address - Phone:202-489-2700
Mailing Address - Fax:
Practice Address - Street 1:8955 EDMONSTON RD UNIT A-C
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1006
Practice Address - Country:US
Practice Address - Phone:202-489-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care