Provider Demographics
NPI:1932814308
Name:VIDA IN HOME CARE LLC
Entity type:Organization
Organization Name:VIDA IN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:IENCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-899-8997
Mailing Address - Street 1:524 GARRISONVILLE RD
Mailing Address - Street 2:PO BOX 151
Mailing Address - City:GARRISONVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22463-9998
Mailing Address - Country:US
Mailing Address - Phone:703-899-8997
Mailing Address - Fax:540-720-5356
Practice Address - Street 1:3 CROSSWOOD PL
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7839
Practice Address - Country:US
Practice Address - Phone:703-899-8997
Practice Address - Fax:540-720-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health