Healthcare Provider Details

I. General information

NPI: 1629942370
Provider Name (Legal Business Name): VIP HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 AGLER RD # 103
COLUMBUS OH
43219-3385
US

IV. Provider business mailing address

3443 AGLER RD # 103
COLUMBUS OH
43219-3385
US

V. Phone/Fax

Practice location:
  • Phone: 614-674-6147
  • Fax:
Mailing address:
  • Phone: 614-674-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MERCEDEZ PICKENS
Title or Position: CEO
Credential:
Phone: 614-674-6147