Healthcare Provider Details

I. General information

NPI: 1891561742
Provider Name (Legal Business Name): VIGILANCE HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SAINT CHARLES DR STE 230
THOUSAND OAKS CA
91360-3982
US

IV. Provider business mailing address

2815 TOWNSGATE RD STE 130
WESTLAKE VILLAGE CA
91361-3089
US

V. Phone/Fax

Practice location:
  • Phone: 708-574-3228
  • Fax:
Mailing address:
  • Phone: 708-574-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN DAVID HELFERT
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 708-574-3228