Healthcare Provider Details

I. General information

NPI: 1508425372
Provider Name (Legal Business Name): VITAL HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S VALLEY VIEW BLVD STE 8
LAS VEGAS NV
89102-0116
US

IV. Provider business mailing address

2801 S VALLEY VIEW BLVD STE 8
LAS VEGAS NV
89102-0116
US

V. Phone/Fax

Practice location:
  • Phone: 702-473-5232
  • Fax: 725-223-4688
Mailing address:
  • Phone: 775-335-7450
  • Fax: 725-223-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: THEOPHILUS AKOH
Title or Position: MANAGER
Credential: PHARMD
Phone: 775-335-7450