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General NPI Number Information
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NPI Number | 1295229524
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Entity Type | Organization
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Legal Business Name | VITAL MED HOME CARE INC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1249 HISTORIC HOMER HWY
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City | HOMER
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State | GA
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Zip | 30547-2738
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Country | US
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Telephone | 678-561-3397
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 233
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City | DACULA
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State | GA
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Zip | 30019-0004
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Country | US
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Telephone | 678-561-3397
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR6
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Name | BIANCA HERRERA
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Credential |
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Telephone | 678-561-3397
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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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