Provider Demographics
NPI:1144873407
Name:AGENCY FOR VITAL SERVICES LLC
Entity type:Organization
Organization Name:AGENCY FOR VITAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GERALDA
Authorized Official - Middle Name:MARIE ALICE
Authorized Official - Last Name:VITAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-714-9462
Mailing Address - Street 1:200 S BISCAYNE BLVD.
Mailing Address - Street 2:SUITE 2790
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131
Mailing Address - Country:US
Mailing Address - Phone:305-714-9462
Mailing Address - Fax:305-402-3307
Practice Address - Street 1:200 S BISCAYNE BLVD.
Practice Address - Street 2:SUITE 2790
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131
Practice Address - Country:US
Practice Address - Phone:305-714-9462
Practice Address - Fax:305-402-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child