Healthcare Provider Details

I. General information

NPI: 1780511618
Provider Name (Legal Business Name): PURE-LIFE SUPPORTIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6339 UNION RD
CLAYTON OH
45315-9753
US

IV. Provider business mailing address

6339 UNION RD
CLAYTON OH
45315-9753
US

V. Phone/Fax

Practice location:
  • Phone: 937-529-6920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: CHUNTELL VAULS
Title or Position: OWNER
Credential:
Phone: 937-529-6920