Healthcare Provider Details

I. General information

NPI: 1376624494
Provider Name (Legal Business Name): VITALITY UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 IDAHO ST
ELKO NV
89801-4611
US

IV. Provider business mailing address

PO BOX 2580
ELKO NV
89803-2580
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-4158
  • Fax:
Mailing address:
  • Phone: 775-738-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNV

VIII. Authorized Official

Name: DOROTHY JEAN DEXTER
Title or Position: CHIEF FINANCIAL OFFICER
Credential: MBA, CPA
Phone: 775-738-4158