Healthcare Provider Details

I. General information

NPI: 1558124693
Provider Name (Legal Business Name): VIVIAN D PRINCE LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIVIAN D PRINCE VIVIAN PRINCE

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 HUNTERWOODS DR
HIGH POINT NC
27265-9573
US

IV. Provider business mailing address

2004 HUNTERWOODS DR
HIGH POINT NC
27265-9573
US

V. Phone/Fax

Practice location:
  • Phone: 336-681-8590
  • Fax:
Mailing address:
  • Phone: 336-303-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberHC5137
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC5137
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHC5137
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC5137
License Number StateNC
# 12
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHC5137
License Number StateNC
# 13
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 14
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC5137
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: