Healthcare Provider Details

I. General information

NPI: 1518308378
Provider Name (Legal Business Name): VINE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 GROVE ST STE 203
WORCESTER MA
01605-1270
US

IV. Provider business mailing address

153 ANDOVER ST SUITE 104
DANVERS MA
01923-1450
US

V. Phone/Fax

Practice location:
  • Phone: 617-681-0825
  • Fax: 877-819-1309
Mailing address:
  • Phone: 978-532-5592
  • Fax: 978-666-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES M NJOROGE
Title or Position: CEO
Credential:
Phone: 508-414-1602