Provider Demographics
NPI:1538126024
Name:VITAL HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:VITAL HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:ABESAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-967-4075
Mailing Address - Street 1:21700 GREENFIELD RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2581
Mailing Address - Country:US
Mailing Address - Phone:248-967-4075
Mailing Address - Fax:248-967-4152
Practice Address - Street 1:21700 GREENFIELD RD
Practice Address - Street 2:SUITE 206
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2581
Practice Address - Country:US
Practice Address - Phone:248-967-4075
Practice Address - Fax:248-967-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237571251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237571Medicare Oscar/Certification