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General NPI Number Information
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NPI Number | 1245035252
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Entity Type | Organization
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Legal Business Name | VITALITY ZONE
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 600 MID CITIES BLVD
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City | HURST
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State | TX
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Zip | 76054-2741
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Country | US
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Telephone | 901-218-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 310 CREIGHTON AVE
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City | RED OAK
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State | TX
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Zip | 75154-1460
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Country | US
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Telephone | 901-218-1119
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MENZISE RICHARDSON
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Credential |
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Telephone | 901-218-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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