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General NPI Number Information
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NPI Number | 1770457533
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Entity Type | Organization
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Legal Business Name | VITALGUARD LLC
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 25463 HAWKS RUN LN
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City | SORRENTO
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State | FL
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Zip | 32776-7736
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Country | US
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Telephone | 978-698-4825
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Fax |
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Provider Business Mailing Address
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Address Line | 25463 HAWKS RUN LN
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City | SORRENTO
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State | FL
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Zip | 32776-7736
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Country | US
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Telephone | 978-698-4825
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | STEPHEN JASS
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Credential |
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Telephone | 352-250-3579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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