MEDICARE: VITAL CARE HOMECARE AGENCY LLC

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	343900000X	Non-emergency Medical Transport (VAN)
4	385H00000X	Respite Care
5	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1437902624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL CARE HOMECARE AGENCY LLC

Provider Business Mailing Address
First Line	:	1006 WHITESVILLE ST APT D414
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240-5355
Country	:	US
Telephone Number	:	706-350-3579
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 GREENVILLE ST STE 4
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-3232
Country	:	US
Telephone Number	:	706-350-3579
Fax Number	:

Authorized Official
Title or Position	:	ADMISTRATOR
Name	:	SHIRELLE BROWN
Credential	:
Telephone Number	:	706-350-3579

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	01/06/2025

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