Healthcare Provider Details

I. General information

NPI: 1417894189
Provider Name (Legal Business Name): VANGUARD HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 JEFFERSON ST # A1
BALTIMORE MD
21205-2318
US

IV. Provider business mailing address

9613C HARFORD RD # 410
PARKVILLE MD
21234-2103
US

V. Phone/Fax

Practice location:
  • Phone: 410-777-5777
  • Fax:
Mailing address:
  • Phone: 410-777-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BUTLER
Title or Position: MANAGING MEMBER
Credential:
Phone: 410-777-5777