Provider Demographics
NPI:1083348676
Name:VITAL HOME HEALTH LLC
Entity Type:Organization
Organization Name:VITAL HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANGCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-385-2852
Mailing Address - Street 1:3135 MOUNTAINSIDE PKWY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-385-2852
Mailing Address - Fax:
Practice Address - Street 1:5345 WYOMING BLVD NE STE 203
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3148
Practice Address - Country:US
Practice Address - Phone:505-433-4228
Practice Address - Fax:505-433-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health