Healthcare Provider Details

I. General information

NPI: 1457920647
Provider Name (Legal Business Name): VITALITY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 09/08/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 GREENFIELD RD STE 200
SOUTHFIELD MI
48075-5346
US

IV. Provider business mailing address

20905 GREENFIELD RD
SOUTHFIELD MI
48075-5360
US

V. Phone/Fax

Practice location:
  • Phone: 248-809-3119
  • Fax: 248-996-8273
Mailing address:
  • Phone: 248-809-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAHIMAH BEN-ASAD RAY-EL
Title or Position: OWNER
Credential:
Phone: 248-809-3119