Provider Demographics
NPI:1407218555
Name:VITAL LIFE HEALTHCARE INC
Entity Type:Organization
Organization Name:VITAL LIFE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-767-1556
Mailing Address - Street 1:13501 SW 136TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8319
Mailing Address - Country:US
Mailing Address - Phone:786-732-2484
Mailing Address - Fax:
Practice Address - Street 1:13501 SW 136TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8319
Practice Address - Country:US
Practice Address - Phone:786-732-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment