Healthcare Provider Details

I. General information

NPI: 1477968758
Provider Name (Legal Business Name): VERO HEALTH IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 WASHINGTON ST
WEST ROXBURY MA
02132-4738
US

IV. Provider business mailing address

10420 LITTLE PATUXENT PKWY STE 210
COLUMBIA MD
21044-3533
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-5440
  • Fax: 617-469-5543
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID VINCENT
Title or Position: PRESIDENT
Credential:
Phone: 410-992-0500