Provider Demographics
NPI:1508408972
Name:VIRTUE INDEPENDENCE, LLC.
Entity Type:Organization
Organization Name:VIRTUE INDEPENDENCE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOELL
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:267-847-2567
Mailing Address - Street 1:306 OVERLOOK LN
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2634
Mailing Address - Country:US
Mailing Address - Phone:484-222-0821
Mailing Address - Fax:
Practice Address - Street 1:306 OVERLOOK LN
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2634
Practice Address - Country:US
Practice Address - Phone:484-222-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10367100Medicaid