Healthcare Provider Details

I. General information

NPI: 1083180012
Provider Name (Legal Business Name): VITALCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 122ND AVE STE 140
WESTMINSTER CO
80234-3440
US

IV. Provider business mailing address

1400 W 122ND AVE STE 140
WESTMINSTER CO
80234-3440
US

V. Phone/Fax

Practice location:
  • Phone: 720-458-0642
  • Fax: 720-815-3372
Mailing address:
  • Phone: 720-458-0642
  • Fax: 720-815-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DOLPH
Title or Position: CEO
Credential:
Phone: 720-458-0643