Provider Demographics
NPI:1558092163
Name:VICEROY HOME HEALTH, LLC
Entity Type:Organization
Organization Name:VICEROY HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-281-6727
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-1343
Mailing Address - Country:US
Mailing Address - Phone:352-281-6727
Mailing Address - Fax:
Practice Address - Street 1:2945 NE 3RD ST STE 203
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-9020
Practice Address - Country:US
Practice Address - Phone:352-281-6727
Practice Address - Fax:352-669-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty