Provider Demographics
NPI:1043805153
Name:VIVAMUS SENIOR CARE LLC
Entity Type:Organization
Organization Name:VIVAMUS SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA L
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALTAZAR MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-730-6481
Mailing Address - Street 1:7106 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3959
Mailing Address - Country:US
Mailing Address - Phone:630-730-6481
Mailing Address - Fax:
Practice Address - Street 1:7106 HIGH RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-3959
Practice Address - Country:US
Practice Address - Phone:630-730-6481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care