Provider Demographics
NPI:1689882334
Name:VIP AMERICA, LLC
Entity Type:Organization
Organization Name:VIP AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTOWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-220-6005
Mailing Address - Street 1:2500 S KANNER HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4600
Mailing Address - Country:US
Mailing Address - Phone:772-220-6005
Mailing Address - Fax:772-220-5867
Practice Address - Street 1:2500 S KANNER HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4600
Practice Address - Country:US
Practice Address - Phone:772-220-6005
Practice Address - Fax:772-220-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNR30210977251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL676037679Medicaid