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General NPI Number Information
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NPI Number | 1083906333
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Entity Type | Organization
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Legal Business Name | VITAL SUPPORT HOME CARE AGENCY, INC.
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 4711 WELLINGTON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19135-1320
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Country | US
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Telephone | 215-379-3300
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Fax | 215-379-3400
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Provider Business Mailing Address
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Address Line | 4711 WELLINGTON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19135-1320
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Country | US
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Telephone | 215-379-3300
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Fax | 215-379-3400
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Authorized Official
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Title or Position | CEO
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Name | MR. ROMAN SHPIGEL
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Credential | MBA
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Telephone | 215-379-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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