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General NPI Number Information
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NPI Number | 1417779323
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Entity Type | Organization
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Legal Business Name | VITAL COMMUNITY CARE
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 5629 BROWNFIELDS DR
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City | BATON ROUGE
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State | LA
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Zip | 70811-1006
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Country | US
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Telephone | 225-444-5004
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Fax |
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Provider Business Mailing Address
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Address Line | 433 KIMMERIDGE DR
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City | BATON ROUGE
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State | LA
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Zip | 70815-6924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ANTWANETTE COLLINS
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Credential |
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Telephone | 225-806-2557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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