Vine Senior Care LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

PCH009193 Issued in GA

Legal business name

VINE SENIOR CARE LLC

Practice address

5111 Spring St
Flowery Branch, GA 30542-3343

Phone

(770) 967-7719

Fax

(770) 967-7719

NPI assigned

Aug 8, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Hae Sook Jang

Title

Owner/Director

Phone

(678) 576-4282

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1502150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1831614148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5111 SPRING ST",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423343",
            "telephone_number": "770-967-7719",
            "fax_number": "770-967-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 SPRING ST",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423343",
            "telephone_number": "770-967-7719",
            "fax_number": "770-967-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINE SENIOR CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JANG",
        "authorized_official_first_name": "HAE SOOK",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "678-576-4282",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "PCH009193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean Lee Varner, FNP-C
• Melissa Lacount Vaughn, LCSW
• Lorraine A Veiga, OTR/L
• Jeannette Velazquez, DPM
• Kristi Villa
• Roberta Doreen Wagner, R.N.
• Walgreen Co
• Walgreen Co
• Danielle A Walker, LCSW
• Davionne Genai Walker, MS, ATC, LAT

• Assisted Living Facility in Flowery Branch, GA
• Providers in Flowery Branch, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.