Provider Demographics
NPI:1225774615
Name:VIP HOMECARE AGENCY LLC
Entity Type:Organization
Organization Name:VIP HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANTAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-441-8005
Mailing Address - Street 1:5115 VINE ST # 16150
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217-7500
Mailing Address - Country:US
Mailing Address - Phone:513-441-8005
Mailing Address - Fax:
Practice Address - Street 1:1821 SUMMIT RD STE 103
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2818
Practice Address - Country:US
Practice Address - Phone:513-441-8005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health