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General NPI Number Information
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NPI Number | 1437949963
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH DIAGNOSTICS & SUPPLIES
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 3203 LAGO VISTA DR
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-8793
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Country | US
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Telephone | 253-441-1071
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Fax |
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Provider Business Mailing Address
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Address Line | 3203 LAGO VISTA DR
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-8793
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Country | US
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Telephone | 253-441-1071
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Fax |
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Authorized Official
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Title or Position | RRT/CEO
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Name | ALICIA LYNN RILEY
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Credential | RRT
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Telephone | 253-441-1071
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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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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2278G1100X
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Taxonomy Name | General Care Certified Respiratory Therapist
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License Number |
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License Number State |
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