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General NPI Number Information
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NPI Number | 1144914011
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Entity Type | Organization
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Legal Business Name | VITALITY CARE LLC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 4518 ASH TREE ST
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City | SNELLVILLE
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State | GA
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Zip | 30039-3361
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Country | US
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Telephone | 404-902-9961
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Fax |
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Provider Business Mailing Address
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Address Line | 285 W WIEUCA RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-3321
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Country | US
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Telephone | 404-902-9961
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | CARLENE MCFAYDEN-KEMP
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Credential | RMA, CNA
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Telephone | 678-215-4591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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