Healthcare Provider Details

I. General information

NPI: 1245167808
Provider Name (Legal Business Name): VITALIS HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N CENTER DR STE A1
ALTON IL
62002-5946
US

IV. Provider business mailing address

200 N CENTER DR STE A1
ALTON IL
62002-5946
US

V. Phone/Fax

Practice location:
  • Phone: 314-328-6067
  • Fax:
Mailing address:
  • Phone: 314-328-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY SLATER
Title or Position: OWNER
Credential:
Phone: 314-328-6067