Provider Demographics
NPI:1497575328
Name:VIVIA HOME CARE WA, LLC
Entity type:Organization
Organization Name:VIVIA HOME CARE WA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEW-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGCAON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-457-1656
Mailing Address - Street 1:820 MILILANI ST STE 711
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2937
Mailing Address - Country:US
Mailing Address - Phone:808-457-1655
Mailing Address - Fax:808-535-1547
Practice Address - Street 1:371 NE GILMAN BLVD STE 160-111
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2901
Practice Address - Country:US
Practice Address - Phone:888-484-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HO'OKELE CARE AT HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health