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General NPI Number Information
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NPI Number | 1659910636
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Entity Type | Organization
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Legal Business Name | VITALITY 360 INC
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Dates
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Enumeration Date | 12/23/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 2442 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21218-5113
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Country | US
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Telephone | 410-413-6786
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Fax | 410-413-6792
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Provider Business Mailing Address
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Address Line | 2442 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21218-5113
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Country | US
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Telephone | 410-413-6786
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Fax | 410-413-6792
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Authorized Official
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Title or Position | OWNER
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Name | CHIMERE BECOTE
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Credential |
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Telephone | 410-805-9464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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