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General NPI Number Information
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NPI Number | 1932814308
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Entity Type | Organization
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Legal Business Name | VIDA IN HOME CARE LLC
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 3 CROSSWOOD PL
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City | STAFFORD
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State | VA
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Zip | 22554-7839
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Country | US
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Telephone | 703-899-8997
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Fax | 540-720-5356
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Provider Business Mailing Address
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Address Line | 524 GARRISONVILLE RD PO BOX 151
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City | GARRISONVILLE
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State | VA
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Zip | 22463-9998
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Country | US
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Telephone | 703-899-8997
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Fax | 540-720-5356
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. MICHEL CHRISTIAN IENCO
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Credential |
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Telephone | 703-899-8997
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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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