Provider Demographics
NPI:1336371236
Name:VITAL SUPPORT SUPPORT COORDINATION AGENCY, INC.
Entity Type:Organization
Organization Name:VITAL SUPPORT SUPPORT COORDINATION AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VARELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-379-3300
Mailing Address - Street 1:333 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2272
Mailing Address - Country:US
Mailing Address - Phone:215-379-3300
Mailing Address - Fax:215-379-3400
Practice Address - Street 1:333 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2272
Practice Address - Country:US
Practice Address - Phone:215-379-3300
Practice Address - Fax:215-379-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization