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General NPI Number Information
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NPI Number | 1700131547
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Entity Type | Organization
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Legal Business Name | VITAL WELLNESS CORPORATION
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 7853 E ARAPAHOE CT SUITE 1100
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City | CENTENNIAL
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State | CO
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Zip | 80112
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Country | US
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Telephone | 630-369-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 HOWARD ST
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City | EVANSTON
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State | IL
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Zip | 60202-3735
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Country | US
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Telephone | 312-989-9260
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Fax | 773-345-4637
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Authorized Official
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Title or Position | CLINICAL OPERATIONS EXECUTIVE
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Name | MR. ALLAN DENNIS ROSALES
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Credential |
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Telephone | 815-272-6292
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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 | 20111674892
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License Number State | CO
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