Healthcare Provider Details

I. General information

NPI: 1083348676
Provider Name (Legal Business Name): VITAL HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 WYOMING BLVD NE STE 203
ALBUQUERQUE NM
87109-3148
US

IV. Provider business mailing address

3135 MOUNTAINSIDE PKWY NE
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-4228
  • Fax: 505-433-4249
Mailing address:
  • Phone: 505-385-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TENZIN YANGCHEN
Title or Position: OWNER
Credential: CNP
Phone: 505-385-2852