Provider Demographics
NPI:1518736297
Name:VITALITY REHAB SERVICES LLC
Entity Type:Organization
Organization Name:VITALITY REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WIDEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-913-1517
Mailing Address - Street 1:1647 SW 22ND TER
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5672
Mailing Address - Country:US
Mailing Address - Phone:863-634-3023
Mailing Address - Fax:
Practice Address - Street 1:4745 FOUR LAKES CIR SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4802
Practice Address - Country:US
Practice Address - Phone:772-913-1517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation