Provider Demographics
NPI:1053578229
Name:VANNA ENTERPRISES, LLC
Entity type:Organization
Organization Name:VANNA ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:DIAZ
Authorized Official - Last Name:PECHILIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-951-2020
Mailing Address - Street 1:225 N CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4247
Mailing Address - Country:US
Mailing Address - Phone:732-296-1119
Mailing Address - Fax:
Practice Address - Street 1:225 N CENTER DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4247
Practice Address - Country:US
Practice Address - Phone:732-296-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0123820Medicaid