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General NPI Number Information
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NPI Number | 1912840406
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Entity Type | Organization
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Legal Business Name | VINTAGE HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 1341 W MOCKINGBIRD LN STE 500W
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City | DALLAS
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State | TX
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Zip | 75247-6903
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Country | US
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Telephone | 214-631-2232
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Fax |
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Provider Business Mailing Address
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Address Line | 17350 STATE HIGHWAY 249
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City | HOUSTON
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State | TX
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Zip | 77064-1147
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. EDRICK BAHAM
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Credential |
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Telephone | 281-912-3503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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