Organization
VASTLAND, LLC
Active
Other names
Vastland Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
WELLINGTON OGUDE (ADMINISTRATOR)
(202) 460-0403
Entity
Organization
Contact information
Practice address
6106 EDMONDSON AVE STE 102&105, CATONSVILLE, MD 21228-1830
(202) 460-0403
(301) 965-8625
Mailing address
6106 EDMONDSON AVE STE 102&105, CATONSVILLE, MD 21228-1830
(202) 460-0403
(301) 965-8625
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
R4101
MD
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5002575-00
—
MD
Enumeration date
10/17/2017
Last updated
07/19/2021
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