MEDICARE: VINTAGE SIGNATURE HOME HEALTH AGENCY LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1437492444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINTAGE SIGNATURE HOME HEALTH AGENCY LLC

Provider Business Mailing Address
First Line	:	6113 LANGLEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-3323
Country	:	US
Telephone Number	:	713-816-2435
Fax Number	:	281-584-0355

Provider Business Practice Location Address
First Line	:	6113 LANGLEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-3323
Country	:	US
Telephone Number	:	713-816-2435
Fax Number	:	281-584-0355

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ESTER WYNN
Credential	:
Telephone Number	:	713-816-2435

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	03/28/2013

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