Healthcare Provider Details

I. General information

NPI: 1962320499
Provider Name (Legal Business Name): VITAL VESSELS MOBILE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 44TH ST SE
KENTWOOD MI
49508-5321
US

IV. Provider business mailing address

2120 44TH ST SE
KENTWOOD MI
49508-5321
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-5701
  • Fax:
Mailing address:
  • Phone: 616-965-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: JOHNNESHA HENDERSON
Title or Position: OWNER
Credential:
Phone: 616-965-5701