Provider Demographics
NPI:1962205302
Name:VIOLET RESIDENTIAL SERVICE AGENCY,LLC
Entity type:Organization
Organization Name:VIOLET RESIDENTIAL SERVICE AGENCY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:BI
Authorized Official - Last Name:NJOMGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-515-0730
Mailing Address - Street 1:9106 SANDRA CT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-3317
Mailing Address - Country:US
Mailing Address - Phone:681-799-6067
Mailing Address - Fax:
Practice Address - Street 1:3800 N EL MIRAGE DR APT 6317
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4083
Practice Address - Country:US
Practice Address - Phone:681-799-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child