Healthcare Provider Details

I. General information

NPI: 1093891301
Provider Name (Legal Business Name): VITAL HOME HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MUNICIPAL DR # 104B
RICHARDSON TX
75080-3541
US

IV. Provider business mailing address

330 MUNICIPAL DR # 104B
RICHARDSON TX
75080-3541
US

V. Phone/Fax

Practice location:
  • Phone: 972-840-1010
  • Fax: 972-840-1011
Mailing address:
  • Phone: 972-840-1010
  • Fax: 972-840-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERLY PHILIPOSE
Title or Position: ADMINISTRATOR
Credential:
Phone: 972-840-1010