MEDICARE: VITALPATH INITIATIVE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1922973502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALPATH INITIATIVE

Provider Business Mailing Address
First Line	:	1 S MAIN ST STE 7
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3225
Country	:	US
Telephone Number	:	216-202-5658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 S MAIN ST STE 7
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3225
Country	:	US
Telephone Number	:	216-202-5658
Fax Number	:

Authorized Official
Title or Position	:	OWNER & CEO
Name	:	CARRIE GRACE
Credential	:	FF2/EMT/MSA/MBA
Telephone Number	:	216-536-2633

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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