Provider Demographics
NPI:1073887246
Name:VITRA HEALTH, INC.
Entity Type:Organization
Organization Name:VITRA HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSHCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-297-2022
Mailing Address - Street 1:150 WOOD ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:508-297-2022
Mailing Address - Fax:508-689-7848
Practice Address - Street 1:150 WOOD ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:508-297-2022
Practice Address - Fax:508-689-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093684BMedicaid
MA110093684AMedicaid