Healthcare Provider Details

I. General information

NPI: 1144873407
Provider Name (Legal Business Name): AGENCY FOR VITAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S BISCAYNE BLVD. SUITE 2790
MIAMI FL
33131
US

IV. Provider business mailing address

200 S BISCAYNE BLVD. SUITE 2790
MIAMI FL
33131
US

V. Phone/Fax

Practice location:
  • Phone: 305-714-9462
  • Fax: 305-402-3307
Mailing address:
  • Phone: 305-714-9462
  • Fax: 305-402-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GERALDA MARIE ALICE VITAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 305-714-9462