Provider Demographics
NPI:1134419294
Name:VESTA INC
Entity type:Organization
Organization Name:VESTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-296-6333
Mailing Address - Street 1:9301 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3115
Mailing Address - Country:US
Mailing Address - Phone:240-296-5930
Mailing Address - Fax:
Practice Address - Street 1:22685 THREE NOTCH RD STE 200
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-3152
Practice Address - Country:US
Practice Address - Phone:301-863-4543
Practice Address - Fax:301-863-4542
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VESTA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-11
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5053251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260991610Medicaid
MD949LOtherMEDICARE
MD1134419294Medicaid