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General NPI Number Information
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NPI Number | 1336949577
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Entity Type | Organization
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Legal Business Name | VINTAGE HEALTHCARE SERVICES L.L.C
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 10310 SWIFT STREAM PL APT 109
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City | COLUMBIA
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State | MD
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Zip | 21044-4881
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Country | US
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Telephone | 202-843-3537
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 CONNECTICUT AVE NW STE 531
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City | WASHINGTON
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State | DC
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Zip | 20036-2729
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Country | US
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Telephone | 202-843-3537
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ELIJAH JONES
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Credential |
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Telephone | 202-843-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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