Provider Demographics
NPI:1558124693
Name:PRINCE, VIVIAN D (LLC)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:D
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:MRS
Other - First Name:VIVIAN
Other - Middle Name:D
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:VIVIAN PRINCE
Mailing Address - Street 1:2004 HUNTERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9573
Mailing Address - Country:US
Mailing Address - Phone:336-303-0292
Mailing Address - Fax:
Practice Address - Street 1:2004 HUNTERWOODS DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9573
Practice Address - Country:US
Practice Address - Phone:336-681-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 174200000X, 261QH0100X, 261QR1300X, 282E00000X, 372600000X, 374U00000X, 385HR2065X
NCHC5137261QR1300X, 251E00000X, 376K00000X, 374U00000X, 385H00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No171000000XOther Service ProvidersMilitary Health Care Provider
No174200000XOther Service ProvidersMeals
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No282E00000XHospitalsLong Term Care Hospital
No376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child