=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275232993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY VITALS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2023
-----------------------------------------------------
Last Update Date | 02/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1182 MARKET ST STE 300
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-4919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-915-0505
-----------------------------------------------------
Fax | 415-915-0909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1182 MARKET ST STE 300
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-4919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-915-0505
-----------------------------------------------------
Fax | 415-915-0909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO & CO-FOUNDER
-----------------------------------------------------
Name | MR. GRANT MADDUX HOWER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-747-4237
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251X00000X
-----------------------------------------------------
Taxonomy Name | Supports Brokerage Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------