Healthcare Provider Details

I. General information

NPI: 1992464127
Provider Name (Legal Business Name): VITA HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14211 E 4TH AVE STE 3-245
AURORA CO
80011-8736
US

IV. Provider business mailing address

14211 E 4TH AVE STE 3-245
AURORA CO
80011-8736
US

V. Phone/Fax

Practice location:
  • Phone: 701-215-9232
  • Fax:
Mailing address:
  • Phone: 701-215-9232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MAWLID A. MOHAMED
Title or Position: OWNER
Credential:
Phone: 701-215-9232