Provider Demographics
NPI:1447696240
Name:VIETWELL CORP
Entity type:Organization
Organization Name:VIETWELL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:KHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-937-7675
Mailing Address - Street 1:124 W PIONEER PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6146
Mailing Address - Country:US
Mailing Address - Phone:817-299-8888
Mailing Address - Fax:817-288-0899
Practice Address - Street 1:124 W PIONEER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6146
Practice Address - Country:US
Practice Address - Phone:817-726-4242
Practice Address - Fax:817-288-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
TX015797251G00000X, 253Z00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015797Medicaid
TX=========Medicaid