Healthcare Provider Details

I. General information

NPI: 1679407621
Provider Name (Legal Business Name): VITALNEST LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2764 W VINCENT ST
SPRINGFIELD MO
65810-1229
US

IV. Provider business mailing address

2764 W VINCENT ST
SPRINGFIELD MO
65810-1229
US

V. Phone/Fax

Practice location:
  • Phone: 417-371-2066
  • Fax:
Mailing address:
  • Phone: 417-371-2066
  • Fax:

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: VIVIAN ARUWAJOYE
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 417-371-2066