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General NPI Number Information
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NPI Number | 1134085038
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Entity Type | Organization
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Legal Business Name | THE VITALITY COLLECTIVE
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 364 WHEELERS FARMS RD UNIT 302
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City | MILFORD
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State | CT
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Zip | 06461-1986
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Country | US
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Telephone | 203-906-2513
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Fax |
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Provider Business Mailing Address
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Address Line | 364 WHEELERS FARMS RD UNIT 302
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City | MILFORD
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State | CT
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Zip | 06461-1986
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Country | US
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Telephone | 203-906-2513
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | CHARLES CHANCIO III
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Credential |
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Telephone | 203-906-2513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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