Provider Demographics
NPI:1003127044
Name:CVIP ENTERPRISES LLC
Entity Type:Organization
Organization Name:CVIP ENTERPRISES LLC
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-714-4260
Mailing Address - Street 1:269 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1519
Mailing Address - Country:US
Mailing Address - Phone:570-714-4260
Mailing Address - Fax:570-208-7952
Practice Address - Street 1:269 BENNETT ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1519
Practice Address - Country:US
Practice Address - Phone:570-714-4260
Practice Address - Fax:570-208-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10223601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10223601OtherPA DEPT OF HEALTH LICENSURE FOR HOME CARE AGENCY