Healthcare Provider Details

I. General information

NPI: 1477712107
Provider Name (Legal Business Name): VINTAGE HEALTH CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20300 GOVERNORS HWY
OLYMPIA FIELDS IL
60461-1011
US

IV. Provider business mailing address

20300 GOVERNORS HWY
OLYMPIA FIELDS IL
60461-1011
US

V. Phone/Fax

Practice location:
  • Phone: 773-368-3499
  • Fax: 630-260-1035
Mailing address:
  • Phone: 773-368-3499
  • Fax: 630-260-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010816
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1010816
License Number StateIL

VIII. Authorized Official

Name: MR. OLIVER AKANO
Title or Position: PRESIDENT
Credential:
Phone: 773-368-3499