Provider Demographics
NPI:1437246030
Name:GO VITALCARE HEALTH SERVICES,INC
Entity Type:Organization
Organization Name:GO VITALCARE HEALTH SERVICES,INC
Other - Org Name:VITAL CARE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OFFIONG
Authorized Official - Middle Name:U
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-494-5141
Mailing Address - Street 1:10701 CORPORATE DR STE 340-105
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4096
Mailing Address - Country:US
Mailing Address - Phone:281-494-5141
Mailing Address - Fax:281-494-5143
Practice Address - Street 1:10701 CORPORATE DR STE 340-105
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4096
Practice Address - Country:US
Practice Address - Phone:281-494-5141
Practice Address - Fax:281-494-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008626251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
679459Medicare ID - Type Unspecified