Provider Demographics
NPI:1598441073
Name:VITOMAH LLC
Entity Type:Organization
Organization Name:VITOMAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MONAH
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:TOE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:218-841-6868
Mailing Address - Street 1:5747 W BROADWAY AVE STE 212B
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3881
Mailing Address - Country:US
Mailing Address - Phone:218-841-6868
Mailing Address - Fax:
Practice Address - Street 1:5747 W BROADWAY AVE STE 212B
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3881
Practice Address - Country:US
Practice Address - Phone:218-841-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)