Provider Demographics
NPI:1770341372
Name:VINE CARE HOME CARE LLC
Entity type:Organization
Organization Name:VINE CARE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKODUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-609-9140
Mailing Address - Street 1:2682 JACANAR LN SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8008
Mailing Address - Country:US
Mailing Address - Phone:678-457-7916
Mailing Address - Fax:
Practice Address - Street 1:2682 JACANAR LN SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8008
Practice Address - Country:US
Practice Address - Phone:678-457-7916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health