Provider Demographics
NPI:1316194210
Name:VITALITY GROUP INC
Entity Type:Organization
Organization Name:VITALITY GROUP INC
Other - Org Name:VITALITY HEALTH SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELOISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-948-7985
Mailing Address - Street 1:19189 W 10 MILE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2453
Mailing Address - Country:US
Mailing Address - Phone:313-388-9740
Mailing Address - Fax:313-388-9741
Practice Address - Street 1:19189 W 10 MILE RD
Practice Address - Street 2:STE 101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2453
Practice Address - Country:US
Practice Address - Phone:313-388-9740
Practice Address - Fax:313-388-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH242410OtherBLUE CROSS
MIMI1115Medicare PIN