Healthcare Provider Details

I. General information

NPI: 1053906461
Provider Name (Legal Business Name): VESTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9946 ELM ST
LANHAM MD
20706-4712
US

IV. Provider business mailing address

9301 ANNAPOLIS RD STE 300
LANHAM MD
20706-3125
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-6300
  • Fax:
Mailing address:
  • Phone: 240-731-6593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SUK-CHING AU-YEUNG
Title or Position: REVENUE MANAGER
Credential:
Phone: 240-731-6593