Provider Demographics
NPI:1417598798
Name:VITALITY HOLISTIC HEALING LLC
Entity Type:Organization
Organization Name:VITALITY HOLISTIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHEM
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:330-524-9881
Mailing Address - Street 1:151 PORTAGE TRAIL
Mailing Address - Street 2:LOWER LEVEL #2
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3251
Mailing Address - Country:US
Mailing Address - Phone:330-524-9881
Mailing Address - Fax:
Practice Address - Street 1:151 PORTAGE TRAIL
Practice Address - Street 2:LOWER LEVEL #2
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-4422
Practice Address - Country:US
Practice Address - Phone:330-524-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty