Healthcare Provider Details

I. General information

NPI: 1942161872
Provider Name (Legal Business Name): VITALMIND RESPONSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 BOARDMAN-CANFIELD ROAD, PMB #339
BOARDMAN OH
44512
US

IV. Provider business mailing address

2864 BEARS DEN CT
YOUNGSTOWN OH
44511-1214
US

V. Phone/Fax

Practice location:
  • Phone: 330-274-4803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: QUAYLA SIMMS
Title or Position: OWNER
Credential: M.A
Phone: 330-518-2156