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Organization
VINTAGE HOMECARE LLC
Active
Organization
VINTAGE HOMECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE DRAGON (OWNER)
(475) 800-7457
Entity
Organization
Contact information
Practice address
675 TOWNSEND AVE UNIT 187, NEW HAVEN, CT 06512-3184
(914) 523-6670
Mailing address
675 TOWNSEND AVE UNIT 187, NEW HAVEN, CT 06512-3184
(914) 523-6670
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
621986
OPTUM
CT
Enumeration date
06/30/2020
Last updated
07/07/2020
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