Provider Demographics
NPI:1962700716
Name:VANTAGE PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:VANTAGE PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-221-1033
Mailing Address - Street 1:1401 UNIVERSITY BLVD E
Mailing Address - Street 2:G111
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4029
Mailing Address - Country:US
Mailing Address - Phone:301-221-1033
Mailing Address - Fax:
Practice Address - Street 1:1401 UNIVERSITY BLVD E
Practice Address - Street 2:G111
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4029
Practice Address - Country:US
Practice Address - Phone:301-221-1033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251300000XAgenciesLocal Education Agency (LEA)
No253Z00000XAgenciesIn Home Supportive Care