Healthcare Provider Details

I. General information

NPI: 1700096930
Provider Name (Legal Business Name): VESTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 INDUSTRIAL PARK DR SUITE A
WALDORF MD
20602-2791
US

IV. Provider business mailing address

9301 ANNAPOLIS RD SUITE 300
LANHAM MD
20706-3115
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-6030
  • Fax: 301-638-9992
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 Number14368
License Number StateMD

VIII. Authorized Official

Name: MR. JIGNESH DALAL
Title or Position: CEO
Credential: CPA
Phone: 240-296-6099