Provider Demographics
NPI:1235996349
Name:VITAL VITA HEALTH, LLC
Entity Type:Organization
Organization Name:VITAL VITA HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBRIK
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:JACOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-981-1006
Mailing Address - Street 1:27156 BURBANK
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2503
Mailing Address - Country:US
Mailing Address - Phone:714-981-1006
Mailing Address - Fax:
Practice Address - Street 1:27156 BURBANK
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2503
Practice Address - Country:US
Practice Address - Phone:714-981-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals