Healthcare Provider Details

I. General information

NPI: 1275232993
Provider Name (Legal Business Name): CITY VITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 MARKET ST STE 300
SAN FRANCISCO CA
94102-4919
US

IV. Provider business mailing address

1182 MARKET ST STE 300
SAN FRANCISCO CA
94102-4919
US

V. Phone/Fax

Practice location:
  • Phone: 415-915-0505
  • Fax: 415-915-0909
Mailing address:
  • Phone: 415-915-0505
  • Fax: 415-915-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GRANT MADDUX HOWER
Title or Position: CFO & CO-FOUNDER
Credential:
Phone: 415-747-4237