Provider Demographics
NPI:1730352725
Name:VASHTI CENTER
Entity type:Organization
Organization Name:VASHTI CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILON
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN-HICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-406-4478
Mailing Address - Street 1:720 TAPESTRY PARK LOOP
Mailing Address - Street 2:SUITE 239
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5511
Mailing Address - Country:US
Mailing Address - Phone:404-942-7688
Mailing Address - Fax:
Practice Address - Street 1:720 TAPESTRY PARK LOOP
Practice Address - Street 2:SUITE 239
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5511
Practice Address - Country:US
Practice Address - Phone:404-942-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONSITE MEDICAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-10
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment