Healthcare Provider Details

I. General information

NPI: 1205337417
Provider Name (Legal Business Name): VITALCARE FAMILY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 12/01/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 ASHLAKE PKWY STE 200
CHESTERFIELD VA
23832-2827
US

IV. Provider business mailing address

7300 ASHLAKE PKWY STE 200
CHESTERFIELD VA
23832-2827
US

V. Phone/Fax

Practice location:
  • Phone: 804-256-8282
  • Fax: 804-256-8288
Mailing address:
  • Phone: 804-256-8282
  • Fax: 804-256-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE NUNN
Title or Position: CFO
Credential:
Phone: 804-614-8190