MEDICARE: VITALWORKS STAFFING AGENCY LLC

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	251E00000X	Home Health Agency
2	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1164384699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALWORKS STAFFING AGENCY LLC

Provider Business Mailing Address
First Line	:	1515 W LAFAYETTE BLVD STE 206
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1926
Country	:	US
Telephone Number	:	313-829-9659
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 W LAFAYETTE BLVD STE 206
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1926
Country	:	US
Telephone Number	:	313-829-9659
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. SHAWN SMITH
Credential	:
Telephone Number	:	313-829-9659

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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