=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932551835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL VIP CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2016
-----------------------------------------------------
Last Update Date | 03/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5601 CORPORATE WAY STE 110
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-268-2531
-----------------------------------------------------
Fax | 561-228-0729
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5601 CORPORATE WAY STE 204
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-268-2531
-----------------------------------------------------
Fax | 561-228-0729
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. LIZ VANESSA VELAZQUEZ MCKINNON
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 561-268-2531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number | 30211899
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 30211899
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------