MEDICARE: VINEYARD HEALTH SERVICES, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		TX

General Provider Information

NPI Number	:	1134447725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINEYARD HEALTH SERVICES, L.L.C.

Provider Business Mailing Address
First Line	:	3936 BOWSTRING BND
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7717
Country	:	US
Telephone Number	:	512-551-3339
Fax Number	:

Provider Business Practice Location Address
First Line	:	3936 BOWSTRING BND
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7717
Country	:	US
Telephone Number	:	512-551-3339
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. ARGELIA C. MARTINEZ
Credential	:
Telephone Number	:	512-551-3339

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	05/07/2010

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