Healthcare Provider Details

I. General information

NPI: 1770248403
Provider Name (Legal Business Name): VITA SANA WELLNESS PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON PL
BOSTON MA
02108-4407
US

IV. Provider business mailing address

PO BOX 692649
QUINCY MA
02269-2649
US

V. Phone/Fax

Practice location:
  • Phone: 617-406-8372
  • Fax:
Mailing address:
  • Phone: 617-406-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. YOLANDA BURRELL
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 617-406-8372