Provider Demographics
NPI:1225423411
Name:VIVID HOME CARE SERVICE INC
Entity Type:Organization
Organization Name:VIVID HOME CARE SERVICE INC
Other - Org Name:VIVID HOME CARE SERVICE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:OGADIMMA
Authorized Official - Last Name:EGWIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-677-3417
Mailing Address - Street 1:1111 COUNTRY TERRACE RD
Mailing Address - Street 2:APARTMENT E
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-4510
Mailing Address - Country:US
Mailing Address - Phone:443-677-3417
Mailing Address - Fax:443-557-1492
Practice Address - Street 1:1111 COUNTRY TERRACE ROAD
Practice Address - Street 2:APARTMENT E
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221
Practice Address - Country:US
Practice Address - Phone:443-677-3417
Practice Address - Fax:443-557-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3696251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health