Healthcare Provider Details

I. General information

NPI: 1275203432
Provider Name (Legal Business Name): JT'TAMA VITAL HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 LAKE WORTH RD STE 201-N
GREENACRES FL
33463-3204
US

IV. Provider business mailing address

5700 LAKE WORTH RD STE 201-N
GREENACRES FL
33463-3204
US

V. Phone/Fax

Practice location:
  • Phone: 561-629-5924
  • Fax:
Mailing address:
  • Phone: 561-629-5924
  • 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: MS. KIMBERLY SANDERS
Title or Position: OWNER
Credential:
Phone: 786-897-2702