Healthcare Provider Details

I. General information

NPI: 1912467788
Provider Name (Legal Business Name): VITAL SKILLS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 N PINE ISLAND RD
SUNRISE FL
33351-6005
US

IV. Provider business mailing address

9376 NW 54TH ST
SUNRISE FL
33351-7788
US

V. Phone/Fax

Practice location:
  • Phone: 954-652-8613
  • Fax:
Mailing address:
  • Phone: 954-652-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ANN MARIE WANLISS
Title or Position: DIRECTOR
Credential: MS, ITDS, BCBA
Phone: 954-652-8613