Organization
VITA BLUE HOMECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE DURAN RN (PRESIDENT/ADMINISTRATOR)
(267) 979-1481
Entity
Organization
Contact information
Practice address
2836 TREMONT ST, 2, PHILADELPHIA, PA 19136-1025
(610) 601-4591
Mailing address
2836 TREMONT ST, 2, PHILADELPHIA, PA 19136-1025
(610) 601-4591
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
36523601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103520828
—
PA
Enumeration date
08/23/2018
Last updated
08/23/2018
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