Provider Demographics
NPI:1720689177
Name:VINEYARD HOME CARE LLC
Entity Type:Organization
Organization Name:VINEYARD HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-694-6227
Mailing Address - Street 1:793 NORGATE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2115
Mailing Address - Country:US
Mailing Address - Phone:201-694-6227
Mailing Address - Fax:
Practice Address - Street 1:793 NORGATE DR
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2115
Practice Address - Country:US
Practice Address - Phone:201-694-6227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health