Healthcare Provider Details

I. General information

NPI: 1396665782
Provider Name (Legal Business Name): VITA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1793 CONCORD HILL DR
ANCHORAGE AK
99515-2542
US

IV. Provider business mailing address

1793 CONCORD HILL DR
ANCHORAGE AK
99515-2542
US

V. Phone/Fax

Practice location:
  • Phone: 907-360-9191
  • Fax: 888-270-7425
Mailing address:
  • Phone: 907-360-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: OLGA LONDON
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-360-9191