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General NPI Number Information
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NPI Number | 1538604533
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Entity Type | Organization
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Legal Business Name | UNITED VITALITY HEALTH
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 318 S. MAIN
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City | PALMYRA
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State | MO
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Zip | 63461
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Country | US
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Telephone | 573-769-0045
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Fax | 573-769-0045
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Provider Business Mailing Address
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Address Line | 318 S. MAIN
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City | PALMYRA
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State | MO
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Zip | 63461
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Country | US
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Telephone | 573-769-0045
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Fax | 573-769-0045
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Authorized Official
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Title or Position | CEO
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Name | MR. CLAY OWEN THORNBURG
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Credential | REGISTERED NURSE
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Telephone | 573-769-0045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 2014026445
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License Number State | MO
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