Provider Demographics
NPI:1699204651
Name:VITA I V LLC
Entity Type:Organization
Organization Name:VITA I V LLC
Other - Org Name:IV BARS OF FLOWER MOUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-899-8820
Mailing Address - Street 1:PO BOX 2066
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 CROSS TIMBERS RD STE 1085
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-8860
Practice Address - Country:US
Practice Address - Phone:469-899-8820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care