Provider Demographics
NPI:1063945889
Name:VINCE MARTIN LLC
Entity type:Organization
Organization Name:VINCE MARTIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AIDE PERSONAL CARE
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CNA
Authorized Official - Phone:540-699-7225
Mailing Address - Street 1:108 BRIDGEWOOD CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 BRIDGEWOOD CT UNIT B
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7741
Practice Address - Country:US
Practice Address - Phone:540-699-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care