MEDICARE: VITAL HOME CARE, 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	332U00000X	Home Delivered Meals
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1831048776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL HOME CARE, LLC

Provider Business Mailing Address
First Line	:	2303 CANEY OAKS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-9080
Country	:	US
Telephone Number	:	904-629-0182
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 CANEY OAKS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-9080
Country	:	US
Telephone Number	:	904-629-0182
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OCTAVIA BLOUNT
Credential	:	RN
Telephone Number	:	904-629-0182

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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