Provider Demographics
NPI:1992372460
Name:VITAL SUPPORT HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:VITAL SUPPORT HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/CFO/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MADINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-736-9321
Mailing Address - Street 1:1508 E BELT LINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6366
Mailing Address - Country:US
Mailing Address - Phone:972-245-2270
Mailing Address - Fax:972-245-2270
Practice Address - Street 1:1508 E BELT LINE RD STE 201
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6366
Practice Address - Country:US
Practice Address - Phone:717-736-9321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health