Healthcare Provider Details

I. General information

NPI: 1790113496
Provider Name (Legal Business Name): VITA HEALTH CARE S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 ANTHONY TRL
NORTHBROOK IL
60062-2014
US

IV. Provider business mailing address

342 ANTHONY TRL
NORTHBROOK IL
60062-2014
US

V. Phone/Fax

Practice location:
  • Phone: 877-968-6388
  • Fax: 877-968-3266
Mailing address:
  • Phone: 877-968-6388
  • Fax: 877-968-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARYA SERDYUKOVA
Title or Position: ADMINISTRATOR
Credential: LCSW, MPH
Phone: 877-968-6388