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General NPI Number Information
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NPI Number | 1841912037
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Entity Type | Organization
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Legal Business Name | VIVID SKY HOME CARE SERVICES
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 59 TIFFANY TRCE
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City | PALMETTO
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State | GA
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Zip | 30268-8544
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Country | US
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Telephone | 678-541-7538
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Fax | 678-692-6562
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Provider Business Mailing Address
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Address Line | 90F GLENDA TRCE # 190
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City | NEWNAN
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State | GA
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Zip | 30265-3858
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Country | US
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Telephone | 678-541-7538
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Fax | 678-692-6562
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PATRICIA M GIBSON
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Credential |
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Telephone | 678-541-7538
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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 |
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License Number State |
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