Provider Demographics
NPI:1861529208
Name:V.I.P. PROIVDERS, INC.
Entity type:Organization
Organization Name:V.I.P. PROIVDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISIDORA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-787-4800
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1616
Mailing Address - Country:US
Mailing Address - Phone:956-787-4800
Mailing Address - Fax:956-787-0067
Practice Address - Street 1:200 E SAM HOUSTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5440
Practice Address - Country:US
Practice Address - Phone:956-787-4800
Practice Address - Fax:956-787-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 3747P1801X
TX006350251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145586165Medicaid
TX000697900Medicaid
TX000119800Medicaid