Provider Demographics
NPI:1093334559
Name:VITALYZE LLC
Entity Type:Organization
Organization Name:VITALYZE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOEMIE
Authorized Official - Middle Name:VALERIE
Authorized Official - Last Name:AKRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-387-3667
Mailing Address - Street 1:40 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3109
Mailing Address - Country:US
Mailing Address - Phone:347-846-1399
Mailing Address - Fax:
Practice Address - Street 1:40 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3109
Practice Address - Country:US
Practice Address - Phone:347-846-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health