Healthcare Provider Details

I. General information

NPI: 1629547559
Provider Name (Legal Business Name): VIRTUOUS HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 LOFTIN ST
TYLER TX
75701-5611
US

IV. Provider business mailing address

832 LOFTIN ST
TYLER TX
75701-5611
US

V. Phone/Fax

Practice location:
  • Phone: 903-593-7770
  • Fax: 903-593-7723
Mailing address:
  • Phone: 903-593-7770
  • Fax: 903-593-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTIE KNOWLTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-593-7770