Provider Demographics
NPI:1215200407
Name:VITAL HOME & HEALTHCARE, INC.
Entity Type:Organization
Organization Name:VITAL HOME & HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAYEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-342-7076
Mailing Address - Street 1:8051 186TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-9341
Mailing Address - Country:US
Mailing Address - Phone:708-342-7076
Mailing Address - Fax:708-342-7083
Practice Address - Street 1:8840 CALUMET AVE
Practice Address - Street 2:SUITE 102B
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2545
Practice Address - Country:US
Practice Address - Phone:219-513-2055
Practice Address - Fax:219-513-2056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITAL HOME & HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-002870-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9953OtherBCBS
IL=========001Medicaid
IL9953OtherBCBS