Healthcare Provider Details

I. General information

NPI: 1619045176
Provider Name (Legal Business Name): VITAL PLUS HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 N MACLAY AVE
SAN FERNANDO CA
91340-1347
US

IV. Provider business mailing address

5401 TECH CIR
MOORPARK CA
93021-1769
US

V. Phone/Fax

Practice location:
  • Phone: 818-551-1900
  • Fax: 818-551-1991
Mailing address:
  • Phone: 818-551-1900
  • Fax: 818-551-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550000243
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY CHILTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-517-1620