Provider Demographics
NPI:1760235261
Name:UNIVERSAL VIBRANT CARE LLC
Entity Type:Organization
Organization Name:UNIVERSAL VIBRANT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TORITSEJU
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEMA-SILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-987-8822
Mailing Address - Street 1:64 BEGONIA ST
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-6291
Mailing Address - Country:US
Mailing Address - Phone:347-987-8822
Mailing Address - Fax:
Practice Address - Street 1:5680 KING CENTRE DR STE 676
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5757
Practice Address - Country:US
Practice Address - Phone:703-402-0395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care