Provider Demographics
NPI:1134350192
Name:VINTAGE FAMILY CARE, LLC
Entity type:Organization
Organization Name:VINTAGE FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-813-8160
Mailing Address - Street 1:1525 OUTERBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-0970
Mailing Address - Country:US
Mailing Address - Phone:281-813-8160
Mailing Address - Fax:214-461-0450
Practice Address - Street 1:1525 OUTERBRIDGE DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-0970
Practice Address - Country:US
Practice Address - Phone:281-813-8160
Practice Address - Fax:214-461-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care