Provider Demographics
NPI:1093559759
Name:VANTAGE AT NEW BEDFORD LLC
Entity type:Organization
Organization Name:VANTAGE AT NEW BEDFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YUROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-558-2685
Mailing Address - Street 1:200 HAWTHORN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2201
Mailing Address - Country:US
Mailing Address - Phone:508-997-9314
Mailing Address - Fax:
Practice Address - Street 1:200 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2201
Practice Address - Country:US
Practice Address - Phone:508-997-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility