Provider Demographics
NPI:1356647887
Name:VIP HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:VIP HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-601-9101
Mailing Address - Street 1:12125 DAY ST
Mailing Address - Street 2:SUITE H306
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6702
Mailing Address - Country:US
Mailing Address - Phone:951-601-9101
Mailing Address - Fax:
Practice Address - Street 1:12125 DAY ST
Practice Address - Street 2:SUITE H306
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6702
Practice Address - Country:US
Practice Address - Phone:951-601-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CA550001969251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health