Provider Demographics
NPI:1528216496
Name:VITAL CARE HOME HEALTH
Entity Type:Organization
Organization Name:VITAL CARE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:FARROW
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:909-882-0101
Mailing Address - Street 1:2130 N ARROWHEAD AVE
Mailing Address - Street 2:SUITE 103C
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4023
Mailing Address - Country:US
Mailing Address - Phone:909-882-0101
Mailing Address - Fax:909-882-0202
Practice Address - Street 1:2130 N ARROWHEAD AVE
Practice Address - Street 2:SUITE 103C
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4023
Practice Address - Country:US
Practice Address - Phone:909-882-0101
Practice Address - Fax:909-882-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty