Provider Demographics
NPI:1407255912
Name:VINEDALE HEALTH CARE, INC.
Entity type:Organization
Organization Name:VINEDALE HEALTH CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SARIBEKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-314-9110
Mailing Address - Street 1:10715 INDIAN HEAD INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1101
Mailing Address - Country:US
Mailing Address - Phone:866-314-9110
Mailing Address - Fax:
Practice Address - Street 1:10715 INDIAN HEAD INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1101
Practice Address - Country:US
Practice Address - Phone:866-314-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies