Provider Demographics
NPI:1801581400
Name:VICE PRESTIGE HEALTHCARE
Entity type:Organization
Organization Name:VICE PRESTIGE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-896-6351
Mailing Address - Street 1:5 GWYNNS MILL CT STE A
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3529
Mailing Address - Country:US
Mailing Address - Phone:443-400-7240
Mailing Address - Fax:
Practice Address - Street 1:5 GWYNNS MILL CT STE A
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3529
Practice Address - Country:US
Practice Address - Phone:443-400-7240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health