Provider Demographics
NPI:1598473415
Name:VITAL HEALTHCARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:VITAL HEALTHCARE SOLUTIONS LLC
Other - Org Name:MAGNOLIA THERAPEUTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:337-831-1704
Mailing Address - Street 1:724 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-4320
Mailing Address - Country:US
Mailing Address - Phone:337-506-2294
Mailing Address - Fax:929-259-5972
Practice Address - Street 1:724 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4320
Practice Address - Country:US
Practice Address - Phone:337-506-2294
Practice Address - Fax:929-259-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health