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General NPI Number Information
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NPI Number | 1962205302
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Entity Type | Organization
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Legal Business Name | VIOLET RESIDENTIAL SERVICE AGENCY,LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 3800 N EL MIRAGE DR APT 6317
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City | AVONDALE
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State | AZ
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Zip | 85392-4083
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Country | US
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Telephone | 681-799-6067
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Fax |
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Provider Business Mailing Address
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Address Line | 9106 SANDRA CT
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-3317
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Country | US
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Telephone | 681-799-6067
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIOLET BI NJOMGERT
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Credential |
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Telephone | 928-515-0730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care 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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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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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