MEDICARE: VITAL HEALTH SERVICES 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	126900000X	Dental Laboratory Technician
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1538965298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1675 MARION BENNET DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 MARION BENNET DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2462
Country	:	US
Telephone Number	:	725-232-8649
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HELEN GRACE MERIDOR
Credential	:
Telephone Number	:	602-814-1554

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	08/30/2025

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Directions to “VITAL HEALTH SERVICES LLC ” Practice Location

Language	Start Address	Practice Location

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