Provider Demographics
NPI:1407652233
Name:VLC III, LLC
Entity type:Organization
Organization Name:VLC III, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NACHTRAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-365-3202
Mailing Address - Street 1:5658 1/2 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1928
Mailing Address - Country:US
Mailing Address - Phone:505-365-3202
Mailing Address - Fax:419-243-0221
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2143
Practice Address - Country:US
Practice Address - Phone:505-477-1138
Practice Address - Fax:575-288-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty