Provider Demographics
NPI:1386974582
Name:DEIRDRE'S VINTAGE HOUSE LLC
Entity type:Organization
Organization Name:DEIRDRE'S VINTAGE HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:440-476-8905
Mailing Address - Street 1:27277 BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1001
Mailing Address - Country:US
Mailing Address - Phone:440-476-8905
Mailing Address - Fax:440-793-6359
Practice Address - Street 1:27277 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-1001
Practice Address - Country:US
Practice Address - Phone:440-476-8905
Practice Address - Fax:440-793-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3270AGH311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home