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General NPI Number Information
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NPI Number | 1932762408
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Entity Type | Organization
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Legal Business Name | VITAL AGENCY LLC
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 12864 FILLMORE STREET NE
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City | BLAINE
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State | MN
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Zip | 55434
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Country | US
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Telephone | 612-275-3889
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Fax |
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Provider Business Mailing Address
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Address Line | 12864 FILLMORE STREET NE
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City | BLAINE
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State | MN
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Zip | 55434
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Country | US
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Telephone | 612-275-3889
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NAMBAGO KALEMA
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Credential |
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Telephone | 612-275-3889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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