MEDICARE: VITAL HOME HEALTH CARE, 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
1	251E00000X	Home Health Agency		CA

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	:	1528050846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL HOME HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	2500 E FOOTHILL BLVD
Second Line	:	STE. 501
City	:	PASADENA
State	:	CA
Zip	:	91107-3464
Country	:	US
Telephone Number	:	626-432-6650
Fax Number	:	626-432-6653

Provider Business Practice Location Address
First Line	:	2500 E FOOTHILL BLVD
Second Line	:	STE. 501
City	:	PASADENA
State	:	CA
Zip	:	91107-3464
Country	:	US
Telephone Number	:	626-432-6650
Fax Number	:	626-432-6653

Authorized Official
Title or Position	:	CEO/ ADMINISTRATOR
Name	:	MRS. ELSA V. LIM
Credential	:	RN
Telephone Number	:	626-432-6650

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/22/2020

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