=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497555189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITAL HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 SE HILLMOOR DR STE B-107A
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-7550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-445-9937
-----------------------------------------------------
Fax | 888-579-1271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 SE HILLMOOR DR STE B-107A
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-7550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-445-9937
-----------------------------------------------------
Fax | 888-579-1271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHRISTINE RIGG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-445-9937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------