Provider Demographics
NPI:1497846992
Name:VITAL SUPPORT HOME HEALTH CARE AGENCY, INC.
Entity Type:Organization
Organization Name:VITAL SUPPORT HOME HEALTH CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHPIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-917-3304
Mailing Address - Street 1:4711 WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1320
Mailing Address - Country:US
Mailing Address - Phone:215-333-6000
Mailing Address - Fax:215-333-5050
Practice Address - Street 1:4711 WELLINGTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1320
Practice Address - Country:US
Practice Address - Phone:215-333-6000
Practice Address - Fax:215-333-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA83918950251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA398070Medicare PIN