Healthcare Provider Details

I. General information

NPI: 1205594280
Provider Name (Legal Business Name): VITAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CORNHUSKER HWY
LINCOLN NE
68507-3123
US

IV. Provider business mailing address

6400 CORNHUSKER HWY
LINCOLN NE
68507-3123
US

V. Phone/Fax

Practice location:
  • Phone: 402-465-5664
  • Fax: 402-465-4065
Mailing address:
  • Phone: 402-465-5664
  • Fax: 402-465-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB AARON HILE
Title or Position: QIDO
Credential: BA
Phone: 402-465-5664