Healthcare Provider Details

I. General information

NPI: 1255622981
Provider Name (Legal Business Name): VESTA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22685 THREE NOTCH RD STE 200
CALIFORNIA MD
20619-3152
US

IV. Provider business mailing address

9301 ANNAPOLIS RD SUITE 300
LANHAM MD
20706-3125
US

V. Phone/Fax

Practice location:
  • Phone: 301-863-4543
  • Fax: 301-863-4542
Mailing address:
  • Phone: 240-296-5848
  • Fax: 301-459-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1475
License Number StateMD

VIII. Authorized Official

Name: LORENA MEMBERG
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 240-296-6333