Provider Demographics
NPI:1639333016
Name:VWELL WEST, INC.
Entity Type:Organization
Organization Name:VWELL WEST, INC.
Other - Org Name:VITAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL OPERATIONS EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-989-9260
Mailing Address - Street 1:1717 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3735
Mailing Address - Country:US
Mailing Address - Phone:888-258-9355
Mailing Address - Fax:630-369-6984
Practice Address - Street 1:1601 BOND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:888-258-9355
Practice Address - Fax:630-369-6984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITAL WELLNESS HOME HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-15
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4404251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147806OtherMEDICARE PROVIDER NUMBER