Provider Demographics
NPI:1659910636
Name:VITALITY 360 INC
Entity Type:Organization
Organization Name:VITALITY 360 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIMERE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-805-9464
Mailing Address - Street 1:2442 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5113
Mailing Address - Country:US
Mailing Address - Phone:410-413-6786
Mailing Address - Fax:410-413-6792
Practice Address - Street 1:2442 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5113
Practice Address - Country:US
Practice Address - Phone:410-413-6786
Practice Address - Fax:410-413-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care