Healthcare Provider Details

I. General information

NPI: 1629323167
Provider Name (Legal Business Name): VINTAGE HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20300 GOVERNORS HWY
OLYMPIA FIELDS IL
60461-1011
US

IV. Provider business mailing address

7 BLANCHARD CIR SUITE 103
WHEATON IL
60189-2037
US

V. Phone/Fax

Practice location:
  • Phone: 630-517-0191
  • Fax: 630-260-1035
Mailing address:
  • Phone: 630-517-0191
  • Fax: 630-260-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4000250
License Number StateIL

VIII. Authorized Official

Name: ENO AKANO
Title or Position: DIRECTOR
Credential:
Phone: 630-517-0191