Organization
VINTAGE SUPPORT GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID JAQUES (PRESIDENT/CEO)
(616) 277-4100
Entity
Organization
Contact information
Practice address
900 ROYAL HEIGHTS RD, BELLEVILLE, IL 62226-5457
(618) 277-4100
Mailing address
900 ROYAL HEIGHTS RD, BELLEVILLE, IL 62226-5457
(618) 277-4100
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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