Provider Demographics
NPI:1417830639
Name:SAINT VINCENT HEALTHCARE PROVIDER, LLC
Entity type:Organization
Organization Name:SAINT VINCENT HEALTHCARE PROVIDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:UNTALAN
Authorized Official - Last Name:GOCHANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-392-9948
Mailing Address - Street 1:253 VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4013
Mailing Address - Country:US
Mailing Address - Phone:707-392-9948
Mailing Address - Fax:
Practice Address - Street 1:253 VOYAGER DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4013
Practice Address - Country:US
Practice Address - Phone:707-392-9948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care