MEDICARE: VIP HOMECARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902324163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP HOMECARE INC

Provider Business Mailing Address
First Line	:	634 VAN DAM ST
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-3537
Country	:	US
Telephone Number	:	845-570-3821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1858 CORNAGA AVE FL 2
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691
Country	:	US
Telephone Number	:	845-570-3821
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YAAKOV M JACOBOVITCH
Credential	:
Telephone Number	:	845-570-3821

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	08/02/2018

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