MEDICARE: VITAL AMBULATORY HEALTHCARE,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	006505	TX

General Provider Information

NPI Number	:	1962405977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL AMBULATORY HEALTHCARE,INC

Provider Business Mailing Address
First Line	:	6666 HARWIN DR
Second Line	:	STE 350
City	:	HOUSTON
State	:	TX
Zip	:	77036-2261
Country	:	US
Telephone Number	:	712-270-6995
Fax Number	:	713-270-0334

Provider Business Practice Location Address
First Line	:	6666 HARWIN DR
Second Line	:	STE 350
City	:	HOUSTON
State	:	TX
Zip	:	77036-2261
Country	:	US
Telephone Number	:	712-270-6995
Fax Number	:	713-270-0334

Authorized Official
Title or Position	:	ADMINISTRATOR/DON
Name	:	MRS. VICTORIA IJEOMA NWABEKE
Credential	:	RN
Telephone Number	:	713-270-6995

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/17/2012

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