=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336144799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITACARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2005
-----------------------------------------------------
Last Update Date | 10/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 W COMMERCE ST
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-752-5900
-----------------------------------------------------
Fax | 214-752-5900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 W COMMERCE ST PO BOX 224785
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75222-4785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-752-5900
-----------------------------------------------------
Fax | 214-752-5900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DANIEL BAERTSCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-752-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0012126
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------