Healthcare Provider Details

I. General information

NPI: 1639040389
Provider Name (Legal Business Name): VITAL CORE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 WELLSTON CT
GLEN ALLEN VA
23059-2615
US

IV. Provider business mailing address

950 WELLSTON CT
GLEN ALLEN VA
23059-2615
US

V. Phone/Fax

Practice location:
  • Phone: 404-444-3334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JOVITA IBEH
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-444-3334