Provider Demographics
NPI:1154944858
Name:VIVID CARE HOME HEALTH
Entity type:Organization
Organization Name:VIVID CARE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORPUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-251-0124
Mailing Address - Street 1:28720 ROADSIDE DR STE 100A
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3302
Mailing Address - Country:US
Mailing Address - Phone:818-251-0124
Mailing Address - Fax:
Practice Address - Street 1:28720 ROADSIDE DR STE 100A
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3302
Practice Address - Country:US
Practice Address - Phone:818-251-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health