Provider Demographics
NPI:1053071878
Name:VITA LONGA HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:VITA LONGA HOME HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKHAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-488-0888
Mailing Address - Street 1:14545 FRIAR ST STE 202-C
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2398
Mailing Address - Country:US
Mailing Address - Phone:929-488-0888
Mailing Address - Fax:818-484-2994
Practice Address - Street 1:14545 FRIAR ST STE 202-C
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2398
Practice Address - Country:US
Practice Address - Phone:929-488-0888
Practice Address - Fax:818-484-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health