Provider Demographics
NPI:1003512120
Name:VIP SENIOR WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:VIP SENIOR WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-942-6595
Mailing Address - Street 1:10115 VISTA POINTE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6329
Mailing Address - Country:US
Mailing Address - Phone:718-942-6595
Mailing Address - Fax:
Practice Address - Street 1:10115 VISTA POINTE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-6329
Practice Address - Country:US
Practice Address - Phone:718-942-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty