Provider Demographics
NPI:1447291570
Name:VANTAGE LTC LIMITED
Entity type:Organization
Organization Name:VANTAGE LTC LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERKOBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-548-5463
Mailing Address - Street 1:11031 PERRY HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-6576
Mailing Address - Country:US
Mailing Address - Phone:800-548-5463
Mailing Address - Fax:814-667-8641
Practice Address - Street 1:11031 PERRY HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-6576
Practice Address - Country:US
Practice Address - Phone:800-548-5463
Practice Address - Fax:814-667-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1112380001Medicare NSC