Provider Demographics
NPI:1407048291
Name:NC-VITAL HEALTHCARE INC.
Entity Type:Organization
Organization Name:NC-VITAL HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEGONYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-437-9530
Mailing Address - Street 1:337 OAKS TRL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4096
Mailing Address - Country:US
Mailing Address - Phone:214-484-3163
Mailing Address - Fax:214-484-3257
Practice Address - Street 1:337 OAKS TRL
Practice Address - Street 2:SUITE 105
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4096
Practice Address - Country:US
Practice Address - Phone:214-484-3163
Practice Address - Fax:214-484-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011866251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-7238Medicare PIN