Provider Demographics
NPI:1336700780
Name:VITALITY TOTAL HOME CARE LLC
Entity Type:Organization
Organization Name:VITALITY TOTAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IBIRONKE
Authorized Official - Middle Name:C
Authorized Official - Last Name:AKINDONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-550-4568
Mailing Address - Street 1:1723 BENT OAK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2140
Mailing Address - Country:US
Mailing Address - Phone:713-550-4569
Mailing Address - Fax:
Practice Address - Street 1:1723 BENT OAK DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2140
Practice Address - Country:US
Practice Address - Phone:713-550-4569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care