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NPI Code Detail

MEDICARE: VITALITY HEALTHCARE INC

MEDICARE: VITALITY HEALTHCARE INC
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
1251E00000XHome Health Agency1921571IL
2251E00000XHome Health Agency1011732IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11010963OTHERILSTATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH

General Provider Information

NPI Number : 1205079985
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITALITY HEALTHCARE INC
Provider Business Mailing Address
First Line : 2025 S ARLINGTON HEIGHTS RD STE 113
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-4141
Country : US
Telephone Number : 847-378-8102
Fax Number : 847-258-5156
Provider Business Practice Location Address
First Line : 2025 S ARLINGTON HEIGHTS RD STE 113
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-4141
Country : US
Telephone Number : 847-378-8102
Fax Number : 847-258-5158
Authorized Official
Title or Position : PRESIDENT/AGENCY SUPERVISOR
Name : JESUSA PASINABO-GARDE
Credential : RN
Telephone Number : 847-378-8102
Provider Enumeration Date : 04/11/2009
Last Update Date : 02/22/2018

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Directions to “VITALITY HEALTHCARE INC ” Practice Location

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