Healthcare Provider Details

I. General information

NPI: 1700979291
Provider Name (Legal Business Name): VITAL HEALTHCARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5936 W. MONTROSE AVE
CHICAGO IL
60634-1628
US

IV. Provider business mailing address

5936 W. MONTROSE AVE
CHICAGO IL
60634-1628
US

V. Phone/Fax

Practice location:
  • Phone: 773-326-6848
  • Fax: 773-202-0208
Mailing address:
  • Phone: 773-326-6848
  • Fax: 773-202-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1010487
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1616835
License Number StateIL

VIII. Authorized Official

Name: MRS. LUCIA SYGACO
Title or Position: PRESIDENT
Credential:
Phone: 773-908-9360