Active NPI
Vastland, LLC
Doing business as Vastland Health Services
- Multi-Specialty Clinic/Center
- Catonsville, MD
National Provider Identifier
1366953416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- VASTLAND, LLC
- Doing business as
- Vastland Health Services
- Practice address
- 6106 Edmondson Ave Ste 102&105
Catonsville, MD 21228-1830 - Phone
- (202) 460-0403
- Fax
- (301) 965-8625
- NPI assigned
- Oct 17, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Wellington Ogude
- Title
- Administrator
- Phone
- (202) 460-0403
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Care Agency | 251J00000X | R4101 | MD | |
| Multi-Specialty Clinic/Center | 261QM1300X | Primary |
Addresses
Primary practice location
6106 Edmondson Ave Ste 102&105
Catonsville, MD 21228-1830
Mailing address
6106 Edmondson Ave Ste 102&105
Catonsville, MD 21228-1830
Phone (202) 460-0403
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5002575-00 | Medicaid | MD |
Other names 1
- Vastland Health Services
National Provider Directory
National Provider Directory- Tax ID family
- Vastland Health Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Locations
6106 Edmondson Ave
Ste 102105
Catonsville, MD 21228
Phone (202) 460-0403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508198400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1626652800000",
"number": "1366953416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6106 EDMONDSON AVE STE 102&105",
"city": "CATONSVILLE",
"state": "MD",
"postal_code": "212281830",
"telephone_number": "202-460-0403",
"fax_number": "301-965-8625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6106 EDMONDSON AVE STE 102&105",
"city": "CATONSVILLE",
"state": "MD",
"postal_code": "212281830",
"telephone_number": "202-460-0403",
"fax_number": "301-965-8625"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VASTLAND, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-10-17",
"last_updated": "2021-07-19",
"certification_date": "2021-07-19",
"status": "A",
"authorized_official_last_name": "OGUDE",
"authorized_official_first_name": "WELLINGTON",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "202-460-0403"
},
"taxonomies": [
{
"code": "251J00000X",
"taxonomy_group": "",
"desc": "Nursing Care",
"state": "MD",
"license": "R4101",
"primary": false
},
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5002575-00",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Vastland Health Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Catonsville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.