Provider Demographics
NPI:1104336817
Name:VANGUARD HEALTHCARE SERVICES
Entity type:Organization
Organization Name:VANGUARD HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DON
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-612-2700
Mailing Address - Street 1:528 WATER BIRCH WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5820
Mailing Address - Country:US
Mailing Address - Phone:678-612-2700
Mailing Address - Fax:678-840-0083
Practice Address - Street 1:528 WATER BIRCH WAY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5820
Practice Address - Country:US
Practice Address - Phone:678-612-2700
Practice Address - Fax:678-840-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-1864251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health