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General NPI Number Information
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NPI Number | 1386974582
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Entity Type | Organization
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Legal Business Name | DEIRDRE'S VINTAGE HOUSE LLC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 27277 BAGLEY RD
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City | OLMSTED FALLS
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State | OH
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Zip | 44138-1001
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Country | US
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Telephone | 440-476-8905
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Fax | 440-793-6359
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Provider Business Mailing Address
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Address Line | 27277 BAGLEY RD
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City | OLMSTED FALLS
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State | OH
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Zip | 44138-1001
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Country | US
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Telephone | 440-476-8905
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Fax | 440-793-6359
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. DEIRDRE FAITH NEWMAN
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Credential | L.P.N.
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Telephone | 440-476-8905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 3270AGH
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License Number State | OH
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