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General NPI Number Information
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NPI Number | 1427869866
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Entity Type | Organization
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Legal Business Name | VINE RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 707 NORRIS LN
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City | ESSEX
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State | MD
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Zip | 21221-2140
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Country | US
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Telephone | 443-473-9773
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Fax | 443-961-8169
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Provider Business Mailing Address
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Address Line | 703 N CAREY ST
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City | BALTIMORE
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State | MD
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Zip | 21217-2412
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Country | US
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Telephone | 443-473-9773
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MARCUS MOTTON
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Credential |
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Telephone | 443-473-9773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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