MEDICARE: VITIALIS ABA THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1023973369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITIALIS ABA THERAPY LLC

Provider Business Mailing Address
First Line	:	2211 MINERVA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-5319
Country	:	US
Telephone Number	:	614-974-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 MINERVA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-5319
Country	:	US
Telephone Number	:	614-974-3318
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SAMATAR HASSAN
Credential	:
Telephone Number	:	614-974-3318

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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