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NPI Code Detail

MEDICARE: VINTAGE SCC LLC

MEDICARE: VINTAGE SCC 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
1310400000XAssisted Living FacilityTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000544OTHERTXFACILITY ID

General Provider Information

NPI Number : 1679718407
Entity Type Code : Organization
Provider Name (Legal Business Name) : VINTAGE SCC LLC
Provider Business Mailing Address
First Line : 205 N BONNIE BRAE ST
Second Line :
City : DENTON
State : TX
Zip : 76201-3766
Country : US
Telephone Number : 940-373-4766
Fax Number : 940-320-6645
Provider Business Practice Location Address
First Line : 205 N BONNIE BRAE ST
Second Line :
City : DENTON
State : TX
Zip : 76201-3766
Country : US
Telephone Number : 940-373-4766
Fax Number : 940-320-6645
Authorized Official
Title or Position : SENIOR VICE PRESIDENT
Name : JASON PRICE
Credential :
Telephone Number : 949-436-4343
Provider Enumeration Date : 12/08/2008
Last Update Date : 09/04/2020

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Directions to “VINTAGE SCC LLC ” Practice Location

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