Provider Demographics
NPI:1295277630
Name:VMAE CORP
Entity type:Organization
Organization Name:VMAE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENDRID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-237-1300
Mailing Address - Street 1:5715 W ALEXANDER RD STE 110A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2815
Mailing Address - Country:US
Mailing Address - Phone:702-333-4373
Mailing Address - Fax:702-333-4337
Practice Address - Street 1:5715 W ALEXANDER RD STE 110A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2815
Practice Address - Country:US
Practice Address - Phone:702-333-4373
Practice Address - Fax:702-333-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100551987Medicaid