MEDICARE: VITAL SUPPORT HOME CARE AGENCY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251X00000X	Supports Brokerage Agency
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1083906333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL SUPPORT HOME CARE AGENCY, INC.

Provider Business Mailing Address
First Line	:	4711 WELLINGTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1320
Country	:	US
Telephone Number	:	215-379-3300
Fax Number	:	215-379-3400

Provider Business Practice Location Address
First Line	:	4711 WELLINGTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1320
Country	:	US
Telephone Number	:	215-379-3300
Fax Number	:	215-379-3400

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROMAN SHPIGEL
Credential	:	MBA
Telephone Number	:	215-379-3300

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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