Provider Demographics
NPI:1538990288
Name:VANTAGE MENTAL HEALTH
Entity type:Organization
Organization Name:VANTAGE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-217-1480
Mailing Address - Street 1:5995 OREN AVE N STE 203
Mailing Address - Street 2:
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6379
Mailing Address - Country:US
Mailing Address - Phone:651-217-1480
Mailing Address - Fax:
Practice Address - Street 1:5995 OREN AVE N STE 203
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-6379
Practice Address - Country:US
Practice Address - Phone:651-217-1480
Practice Address - Fax:833-972-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty