Provider Demographics
NPI:1992204598
Name:VINEYARD AT HOME SERVICES
Entity Type:Organization
Organization Name:VINEYARD AT HOME SERVICES
Other - Org Name:VINEYARD AT HOME SERVIES
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-566-2388
Mailing Address - Street 1:1010 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5633
Mailing Address - Country:US
Mailing Address - Phone:214-566-2388
Mailing Address - Fax:
Practice Address - Street 1:1010 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-5633
Practice Address - Country:US
Practice Address - Phone:214-566-2388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care