MEDICARE: VAND V HEALTHCARE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251J00000X	Nursing Care Agency
3	251K00000X	Public Health or Welfare Agency
4	251T00000X	PACE Provider Organization
5	251X00000X	Supports Brokerage Agency
6	253Z00000X	In Home Supportive Care Agency
7	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1376186825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAND V HEALTHCARE SERVICE

Provider Business Mailing Address
First Line	:	P.O. BOX 7451
Second Line	:	7451
City	:	FREEPORT
State	:	NY
Zip	:	11520-7451
Country	:	US
Telephone Number	:	516-580-6739
Fax Number	:	516-280-8606

Provider Business Practice Location Address
First Line	:	132 WEST MERRICK ROAD
Second Line	:	BX 7451
City	:	FREEPORT
State	:	NY
Zip	:	11520-7451
Country	:	US
Telephone Number	:	516-580-6739
Fax Number	:	516-280-8606

Authorized Official
Title or Position	:	OWNER
Name	:	MS. VERONICA D BUCKLES
Credential	:
Telephone Number	:	516-580-6739

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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