Healthcare Provider Details

I. General information

NPI: 1801683313
Provider Name (Legal Business Name): NICHOLAS GABRIEL VECE QMHA-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SUNSET DR
LA GRANDE OR
97850-1200
US

IV. Provider business mailing address

200 2ND ST
LA GRANDE OR
97850-1114
US

V. Phone/Fax

Practice location:
  • Phone: 541-663-3150
  • Fax: 541-975-5111
Mailing address:
  • Phone: 503-442-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number25-QMHA-I-004989
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: