MEDICARE: VITAL ALLIANCE HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013538891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL ALLIANCE HOME CARE

Provider Business Mailing Address
First Line	:	3629 WHITEHALL LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1826
Country	:	US
Telephone Number	:	267-565-9406
Fax Number	:

Provider Business Practice Location Address
First Line	:	3629 WHITEHALL LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1826
Country	:	US
Telephone Number	:	267-565-9406
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTIN MORRISON
Credential	:
Telephone Number	:	267-565-9406

Provider Enumeration Date	:	05/02/2020
Last Update Date	:	05/02/2020

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