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General NPI Number Information
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NPI Number | 1568333078
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Entity Type | Organization
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Legal Business Name | VITA FIDELIS LLC
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 879 PARK AVE W
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City | MANSFIELD
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State | OH
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Zip | 44906-2944
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Country | US
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Telephone | 760-458-5111
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Fax | 419-709-9044
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Provider Business Mailing Address
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Address Line | 879 PARK AVE W
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City | MANSFIELD
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State | OH
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Zip | 44906-2944
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Country | US
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Telephone | 760-458-5111
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Fax | 419-709-9044
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Authorized Official
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Title or Position | OWNER
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Name | PAMELA LUCILLE KASS
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Credential | PMHNP-BC
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Telephone | 760-458-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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