Healthcare Provider Details

I. General information

NPI: 1053702035
Provider Name (Legal Business Name): VIVID HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 FITZPATRICK RD
NASHVILLE TN
37214
US

IV. Provider business mailing address

770 FITZPATRICK RD
NASHVILLE TN
37214
US

V. Phone/Fax

Practice location:
  • Phone: 615-784-3363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY DONELSON
Title or Position: MEMBER
Credential:
Phone: 615-784-3363