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General NPI Number Information
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NPI Number | 1841087848
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Entity Type | Organization
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Legal Business Name | VITALITY ADULT FOSTER CARE HOME CO
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 11445 MINDEN ST
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City | DETROIT
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State | MI
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Zip | 48205-3762
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Country | US
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Telephone | 248-995-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 26026 TELEGRAPH RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48033-2560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | BRENAE P WEAVER
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Credential | RN
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Telephone | 248-995-5410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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