Healthcare Provider Details

I. General information

NPI: 1508776212
Provider Name (Legal Business Name): VITRA HEALTH OF SOUTH DAKOTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 BOYLSTON ST STE 400
BOSTON MA
02116-2658
US

IV. Provider business mailing address

745 BOYLSTON ST STE 400
BOSTON MA
02116-2658
US

V. Phone/Fax

Practice location:
  • Phone: 508-297-2022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: LORENA SILVA
Title or Position: CEO
Credential:
Phone: 508-297-2022