Provider Demographics
NPI:1548465347
Name:VINE CARE CENTER INC
Entity type:Organization
Organization Name:VINE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY CONTROL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NKECHI
Authorized Official - Middle Name:PERPETUA
Authorized Official - Last Name:ANWULI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-677-7900
Mailing Address - Street 1:890 OAK VALLEY PKWY
Mailing Address - Street 2:C
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8701
Mailing Address - Country:US
Mailing Address - Phone:951-845-7774
Mailing Address - Fax:951-845-0449
Practice Address - Street 1:890 OAK VALLEY PKWY
Practice Address - Street 2:C
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8701
Practice Address - Country:US
Practice Address - Phone:951-845-7774
Practice Address - Fax:951-845-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330079AN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty