Healthcare Provider Details

I. General information

NPI: 1336022938
Provider Name (Legal Business Name): VITAL HEALTH HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 NW 29TH ST
SUNRISE FL
33313-1109
US

IV. Provider business mailing address

6401 NW 29TH ST
SUNRISE FL
33313-1109
US

V. Phone/Fax

Practice location:
  • Phone: 786-352-7120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE TERRY
Title or Position: OWNER
Credential:
Phone: 786-352-7120