MEDICARE: VITAL ENRICHMENT RESOURCES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency
4	310400000X	Assisted Living Facility
5	332U00000X	Home Delivered Meals
6	347C00000X	Private Vehicle
7	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1063899573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL ENRICHMENT RESOURCES

Provider Business Mailing Address
First Line	:	6300 MILGEN RD
Second Line	:	APT 1283
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5889
Country	:	US
Telephone Number	:	706-315-9592
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 MILGEN RD
Second Line	:	APT 1283
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5889
Country	:	US
Telephone Number	:	706-315-9592
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATRINA WALKER
Credential	:
Telephone Number	:	706-315-9592

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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Directions to “VITAL ENRICHMENT RESOURCES ” Practice Location

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