1013198977 NPI number — VITAL SOLUTIONS HOME HEALTH AGENCY, INC

Table of content: SHRIPAL KUNJBHARI MAKIM MD (NPI 1104900141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013198977 NPI number — VITAL SOLUTIONS HOME HEALTH AGENCY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL SOLUTIONS HOME HEALTH AGENCY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013198977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12525 ORANGE DR
Provider Second Line Business Mailing Address:
SUITE # 710
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33330-4308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-475-2613
Provider Business Mailing Address Fax Number:
954-475-2614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12525 ORANGE DR
Provider Second Line Business Practice Location Address:
SUITE # 710
Provider Business Practice Location Address City Name:
DAVIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33330-4308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-475-2613
Provider Business Practice Location Address Fax Number:
954-475-2614
Provider Enumeration Date:
11/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
954-865-3318

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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