Healthcare Provider Details

I. General information

NPI: 1407773047
Provider Name (Legal Business Name): VITALITY HOME SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 FALLING BROOK TER
ADELPHI MD
20783-1450
US

IV. Provider business mailing address

2705 FALLING BROOK TER
ADELPHI MD
20783-1450
US

V. Phone/Fax

Practice location:
  • Phone: 301-637-7924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN NJINJOH
Title or Position: OWNER
Credential:
Phone: 301-637-7963