Healthcare Provider Details

I. General information

NPI: 1992372460
Provider Name (Legal Business Name): VITAL SUPPORT HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 LITTLE ELM PKWY STE 1502
LITTLE ELM TX
75068-2503
US

IV. Provider business mailing address

2601 LITTLE ELM PKWY STE 1502
LITTLE ELM TX
75068-2503
US

V. Phone/Fax

Practice location:
  • Phone: 972-245-2270
  • Fax: 972-245-2271
Mailing address:
  • Phone: 972-245-2270
  • Fax: 972-245-2271

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: MADINA HASSON
Title or Position: ADMINISTRAOR
Credential:
Phone: 972-245-2270