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General NPI Number Information
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NPI Number | 1972429850
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Entity Type | Organization
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Legal Business Name | VINTAGE BEHAVIORAL HEALTHCARE CENTER LLC
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 4041 POWDER MILL RD STE 322B
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City | BELTSVILLE
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State | MD
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Zip | 20705-3106
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Country | US
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Telephone | 240-388-9096
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Fax |
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Provider Business Mailing 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 |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIJAH JONES
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Credential | CEO
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Telephone | 202-843-3537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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