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General NPI Number Information
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NPI Number | 1801568225
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 400 PLAZA CIR STE G
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City | CLINTON
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State | SC
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Zip | 29325-7558
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Country | US
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Telephone | 864-403-9150
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Fax |
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Provider Business Mailing Address
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Address Line | 400 PLAZA CIR STE G
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City | CLINTON
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State | SC
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Zip | 29325-7558
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Country | US
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Telephone | 864-403-9150
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. TYRONE G ROBERSON SR.
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Credential | APRN
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Telephone | 864-403-9150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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