Provider Demographics
NPI:1346561651
Name:VINE HEALTH CARE INC
Entity type:Organization
Organization Name:VINE HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SELLYNE
Authorized Official - Middle Name:ADHIAMBO
Authorized Official - Last Name:AUDI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-304-2733
Mailing Address - Street 1:26359 JEFFERSON AVE STE H
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6975
Mailing Address - Country:US
Mailing Address - Phone:951-304-2733
Mailing Address - Fax:951-894-4682
Practice Address - Street 1:26359 JEFFERSON AVE STE H
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6975
Practice Address - Country:US
Practice Address - Phone:951-304-2733
Practice Address - Fax:951-894-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health