Healthcare Provider Details

I. General information

NPI: 1144141227
Provider Name (Legal Business Name): VITALNEST HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 JENNIFER LN
JORDAN MN
55352-1019
US

IV. Provider business mailing address

905 BRADBURY CIR
JORDAN MN
55352-1467
US

V. Phone/Fax

Practice location:
  • Phone: 608-746-9037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: YANKUBA JANNEH
Title or Position: OWNER
Credential:
Phone: 608-746-9037