VINTAGE GRACE (NPI# 1700902590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700902590 |
| Entity Type | Organization |
| Organization Name | VINTAGE GRACE |
| Practice Address |
12 Peabody Rd Derry NH 03038-1838 |
| Practice Telephone | 6034256339 |
| Practice Fax Number | 6034219367 |
| Mailing Telephone | 6034256339 |
| Mailing Fax Number | 6034219367 |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-05-29 |
| Authorized Official Name | AMY BIZEUR (DIRECTOR) |
| Authorized Official Telephone | 6034256339 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251T00000X | PACE Provider Organization | 251T00000X | NH | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NH | 30009905 | 05 | |
| NH | 30009906 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | VINTAGE GRACE | 2917 4 Th Street, Hubbard, OR 97032 |
| Washington State Corporations | VINTAGE GRACE LLC | 28413 76th Ave E, Graham, WA 98338 |
| Colorado Business Entities | Vintage Grace, LLC | 4407 W. 29th Street, Greeley, CO 80634 |
| Street Address |
12 PEABODY RD |
| City | DERRY |
| State | NH |
| Zip Code | 03038-1838 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750922142 | Derry Surgical Center, LLC | Clinic/Center | 15 Tsienneto Road, Derry, NH 03038 | 2019-10-07 |
| 1265941769 | Shireen Kirata | Physician Assistant | Lahey Institute of Urology, Derry, 44 Birch Street, Derry, NH 03038 | 2017-09-27 |
| 1538615133 | Louise Dinsmore | Pharmacist | 48 East Broadway, Derry, NH 03038 | 2016-09-01 |
| 1295188852 | Lauren Manney | Pharmacist | 48 E. Broadway, Derry, NH 03038 | 2016-07-19 |
| 1396104857 | Simply Orthodontics, Nh, PC | Dentist | 8 Crystal Ave, Derry, NH 03038 | 2016-02-12 |
| 1659766996 | Beverly Stasia Weston | Adult Companion | 60 Frost Rd, Derry, NH 03038 | 2015-04-03 |
| 1639580038 | Tricia Lane | Nurse Practitioner | 1 Parkland Drive, Derry, NH 03038 | 2014-05-20 |
| 1841620382 | Rothenwitz Dental Partnership | Dentist | 19d Manchester Rd, Suite 3, Derry, NH 03038 | 2013-11-20 |
| 1184934978 | Colleen Summers | Nurse Practitioner | 6 Tsiennto Road, Suite 101ll, Derry, NH 03038 | 2010-10-14 |
| 1609016922 | Bethany Lynne Layne | Physical Therapist | 8 White Oak Lane, Derry, NH 03038 | 2009-02-26 |
| Find all providers in zip 03038 | ||||
| Taxonomy Code | 251T00000X |
| Grouping | Agencies |
| Classification | PACE Provider Organization |
| A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. |
| Notes: Source: Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new] |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.