MEDICARE: VITAL SOURCE HEALTHCARE

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1619828399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL SOURCE HEALTHCARE

Provider Business Mailing Address
First Line	:	18306 FLINT HILL DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-8417
Country	:	US
Telephone Number	:	214-560-8527
Fax Number	:

Provider Business Practice Location Address
First Line	:	18306 FLINT HILL DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-8417
Country	:	US
Telephone Number	:	214-560-8527
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ESTHER EHIRIM
Credential	:
Telephone Number	:	214-560-8527

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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