Provider Demographics
NPI:1255038477
Name:VINTAGE PSYCHIATRIC CARE
Entity type:Organization
Organization Name:VINTAGE PSYCHIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:VADA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKE-GASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-237-0399
Mailing Address - Street 1:7163 HIAWASSEE OAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8357
Mailing Address - Country:US
Mailing Address - Phone:407-237-0399
Mailing Address - Fax:
Practice Address - Street 1:7163 HIAWASSEE OAK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8357
Practice Address - Country:US
Practice Address - Phone:407-237-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care