Healthcare Provider Details

I. General information

NPI: 1962205302
Provider Name (Legal Business Name): VIOLET RESIDENTIAL SERVICE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N EL MIRAGE DR APT 6317
AVONDALE AZ
85392-4083
US

IV. Provider business mailing address

9106 SANDRA CT
RANDALLSTOWN MD
21133-3317
US

V. Phone/Fax

Practice location:
  • Phone: 928-515-0730
  • Fax:
Mailing address:
  • Phone: 681-799-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: VIOLET BI NJOMGERT
Title or Position: OWNER
Credential:
Phone: 928-515-0730