Provider Demographics
NPI:1275203432
Name:JT'TAMA VITAL HOME CARE, INC
Entity Type:Organization
Organization Name:JT'TAMA VITAL HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-897-2702
Mailing Address - Street 1:5700 LAKE WORTH RD STE 201-N
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3204
Mailing Address - Country:US
Mailing Address - Phone:561-629-5924
Mailing Address - Fax:
Practice Address - Street 1:5700 LAKE WORTH RD STE 201-N
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3204
Practice Address - Country:US
Practice Address - Phone:561-629-5924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care