Healthcare Provider Details

I. General information

NPI: 1053235515
Provider Name (Legal Business Name): VITALITY TRANSPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

IV. Provider business mailing address

6667 94TH ST S
COTTAGE GROVE MN
55016-3968
US

V. Phone/Fax

Practice location:
  • Phone: 414-414-7717
  • Fax:
Mailing address:
  • Phone: 612-433-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: AHMED ABDALLA
Title or Position: OWNER
Credential:
Phone: 612-433-3627