Provider Demographics
NPI:1366846669
Name:VIVID HELPERS
Entity Type:Organization
Organization Name:VIVID HELPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL ANNA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GARRAWAY-PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-579-1013
Mailing Address - Street 1:74 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3417
Mailing Address - Country:US
Mailing Address - Phone:862-579-1013
Mailing Address - Fax:
Practice Address - Street 1:74 HOWARD ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3417
Practice Address - Country:US
Practice Address - Phone:862-579-1013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTP0406300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health