Provider Demographics
NPI:1588393110
Name:MARCY'S VANTAGE CARE, LLC
Entity type:Organization
Organization Name:MARCY'S VANTAGE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-251-7523
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:PONCA
Mailing Address - State:NE
Mailing Address - Zip Code:68770-0645
Mailing Address - Country:US
Mailing Address - Phone:712-251-7523
Mailing Address - Fax:402-755-2387
Practice Address - Street 1:104 S EAST ST
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770-7264
Practice Address - Country:US
Practice Address - Phone:712-251-7523
Practice Address - Fax:402-755-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty