MEDICARE: VINTAGE HEALTHCARE SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1912840406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINTAGE HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	17350 STATE HIGHWAY 249
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 W MOCKINGBIRD LN STE 500W
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-6903
Country	:	US
Telephone Number	:	214-631-2232
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. EDRICK BAHAM
Credential	:
Telephone Number	:	281-912-3503

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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Directions to “VINTAGE HEALTHCARE SERVICES LLC ” Practice Location

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