Healthcare Provider Details

I. General information

NPI: 1659910636
Provider Name (Legal Business Name): VITALITY 360 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 N CHARLES ST
BALTIMORE MD
21218-5113
US

IV. Provider business mailing address

2442 N CHARLES ST
BALTIMORE MD
21218-5113
US

V. Phone/Fax

Practice location:
  • Phone: 410-413-6786
  • Fax: 410-413-6792
Mailing address:
  • Phone: 410-413-6786
  • Fax: 410-413-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHIMERE BECOTE
Title or Position: OWNER
Credential:
Phone: 410-805-9464