Healthcare Provider Details

I. General information

NPI: 1134116809
Provider Name (Legal Business Name): VIALIFE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ROWE ST
PRYOR OK
74361-4606
US

IV. Provider business mailing address

100 S ROWE ST
PRYOR OK
74361-4606
US

V. Phone/Fax

Practice location:
  • Phone: 918-824-9600
  • Fax: 918-824-4445
Mailing address:
  • Phone: 918-824-9600
  • Fax: 918-824-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7795
License Number StateOK

VIII. Authorized Official

Name: ALESHA PENDERSON
Title or Position: CEO
Credential:
Phone: 918-824-9600