Provider Demographics
NPI:1134116809
Name:VIALIFE CORPORATION
Entity Type:Organization
Organization Name:VIALIFE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-557-4376
Mailing Address - Street 1:100 S ROWE ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4606
Mailing Address - Country:US
Mailing Address - Phone:918-824-9600
Mailing Address - Fax:918-824-4445
Practice Address - Street 1:100 S ROWE ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4606
Practice Address - Country:US
Practice Address - Phone:918-824-9600
Practice Address - Fax:918-824-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-28
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7795251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-7689Medicare ID - Type UnspecifiedHOME HEALTH AGENCY