Vine Health Care

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

MH2147 Issued in MD

Legal business name

VINE HEALTH CARE

Doing business as

Vine Health Care, Inc

Practice address

7131 Liberty Rd Ste 200
Baltimore, MD 21207-4599

Phone

(443) 850-1967

NPI assigned

Oct 6, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Oluwafemi Moyoade Ikusika

Title

C.E.O

Phone

(443) 621-1931

Specialties & licenses 1

Addresses

Other names 1

• VINE HEALTH CARE, INC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597622400000",
    "number": "1114477718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7131 LIBERTY RD STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212074599",
            "telephone_number": "410-637-3005",
            "fax_number": "410-510-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7131 LIBERTY RD STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212074599",
            "telephone_number": "443-850-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINE HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-06",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A",
        "authorized_official_last_name": "IKUSIKA",
        "authorized_official_first_name": "OLUWAFEMI",
        "authorized_official_middle_name": "MOYOADE",
        "authorized_official_title_or_position": "C.E.O",
        "authorized_official_telephone_number": "443-621-1931"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": "MH2147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VINE HEALTH CARE, INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vincent M. Notarangelo, MD, PA
• Elizabeth Kemmerer Vincent
• Jasmaude Vincent
• Margaret Louise Vincent, LCSW
• Donna Marie Vincenti, M.D.
• Gilbert Emmanuel Gecole Vinegas, CRNP
• Gloria S Vines, LCSW-C
• Javan Vines
• Vineyard Behavioral Health Services
• Vineyard Gentle Care LLC

• Community/Behavioral Health Agency in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.