Provider Demographics
NPI:1841912037
Name:VIVID SKY HOME CARE SERVICES
Entity type:Organization
Organization Name:VIVID SKY HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-541-7538
Mailing Address - Street 1:90F GLENDA TRCE # 190
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3858
Mailing Address - Country:US
Mailing Address - Phone:678-541-7538
Mailing Address - Fax:678-692-6562
Practice Address - Street 1:59 TIFFANY TRCE
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-8544
Practice Address - Country:US
Practice Address - Phone:678-541-7538
Practice Address - Fax:678-692-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health