Healthcare Provider Details

I. General information

NPI: 1750267571
Provider Name (Legal Business Name): VANTAGE AT ANDOVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ANDOVER ST
ANDOVER MA
01810-5606
US

IV. Provider business mailing address

80 ANDOVER ST
ANDOVER MA
01810-5606
US

V. Phone/Fax

Practice location:
  • Phone: 978-470-3434
  • Fax:
Mailing address:
  • Phone: 978-470-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SAM YUROWITZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 845-558-2685