Provider Demographics
NPI:1700372869
Name:VALERIE M VINSON-ANDERSON
Entity Type:Organization
Organization Name:VALERIE M VINSON-ANDERSON
Other - Org Name:VALERIE COMPASSIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:VINSON-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-763-3922
Mailing Address - Street 1:12397 CADLEY CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-1860
Mailing Address - Country:US
Mailing Address - Phone:904-763-3922
Mailing Address - Fax:904-339-9315
Practice Address - Street 1:12397 CADLEY CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-1860
Practice Address - Country:US
Practice Address - Phone:904-763-3922
Practice Address - Fax:904-339-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235084253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021829600Medicaid