Provider Demographics
NPI:1972872661
Name:COMPREHENSIVE VINE HEALTH SERVICES
Entity Type:Organization
Organization Name:COMPREHENSIVE VINE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:QUINTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:404-796-6511
Mailing Address - Street 1:1978 SCARBROUGH DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-4422
Mailing Address - Country:US
Mailing Address - Phone:404-796-6511
Mailing Address - Fax:678-550-9140
Practice Address - Street 1:1978 SCARBROUGH DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-4422
Practice Address - Country:US
Practice Address - Phone:404-796-6511
Practice Address - Fax:678-550-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-26
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN10908251S00000X
GARN109088253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care