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General NPI Number Information
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NPI Number | 1497846992
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Entity Type | Organization
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Legal Business Name | VITAL SUPPORT HOME HEALTH CARE AGENCY, INC.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 12/01/2011
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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 | 215-333-6000
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Fax | 215-333-5050
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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 | 215-333-6000
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Fax | 215-333-5050
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROMAN A SHPIGEL
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Credential |
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Telephone | 215-917-3304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 83918950
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License Number State | PA
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