Healthcare Provider Details

I. General information

NPI: 1427649227
Provider Name (Legal Business Name): VINE HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 07/14/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25615 COUNTY ROAD 460
TRINITY AL
35673-4947
US

IV. Provider business mailing address

25615 COUNTY ROAD 460
TRINITY AL
35673-4947
US

V. Phone/Fax

Practice location:
  • Phone: 256-716-8262
  • Fax: 256-615-8629
Mailing address:
  • Phone: 256-716-8262
  • Fax: 256-615-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS ARRIGNTON
Title or Position: OWNER
Credential:
Phone: 256-716-8262