Provider Demographics
NPI:1568152098
Name:VIP COMMUNITY HEALTH LLC
Entity Type:Organization
Organization Name:VIP COMMUNITY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-543-7557
Mailing Address - Street 1:3064 PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WADDY
Mailing Address - State:KY
Mailing Address - Zip Code:40076-6107
Mailing Address - Country:US
Mailing Address - Phone:270-543-7557
Mailing Address - Fax:
Practice Address - Street 1:503 HUMSTON DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1927
Practice Address - Country:US
Practice Address - Phone:270-543-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care