MEDICARE: VITAL SUPPORT HOME HEALTH CARE LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1992372460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL SUPPORT HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	2601 LITTLE ELM PKWY STE 1502
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-2503
Country	:	US
Telephone Number	:	972-245-2270
Fax Number	:	972-245-2271

Provider Business Practice Location Address
First Line	:	2601 LITTLE ELM PKWY STE 1502
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-2503
Country	:	US
Telephone Number	:	972-245-2270
Fax Number	:	972-245-2271

Authorized Official
Title or Position	:	ADMINISTRAOR
Name	:	MADINA HASSON
Credential	:
Telephone Number	:	972-245-2270

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	02/20/2025

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