Healthcare Provider Details

I. General information

NPI: 1730361023
Provider Name (Legal Business Name): VITAL HEALTH CARE & ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 S CHURCH AVE
LOUISVILLE MS
39339-3447
US

IV. Provider business mailing address

870 S CHURCH AVE
LOUISVILLE MS
39339-3447
US

V. Phone/Fax

Practice location:
  • Phone: 662-779-2004
  • Fax: 662-779-2024
Mailing address:
  • Phone: 662-779-2004
  • Fax: 662-779-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateMS

VIII. Authorized Official

Name: MRS. CLAUDIA L STONE
Title or Position: OWNER
Credential:
Phone: 662-779-2004