Provider Demographics
NPI:1669038170
Name:VITAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:VITAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARNEOND-KHALILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-830-1992
Mailing Address - Street 1:2755 CHESTNUT RIDGE DR APT 118
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2498
Mailing Address - Country:US
Mailing Address - Phone:281-915-9828
Mailing Address - Fax:281-972-5335
Practice Address - Street 1:2755 CHESTNUT RIDGE DR APT 118
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2498
Practice Address - Country:US
Practice Address - Phone:281-915-9828
Practice Address - Fax:281-972-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health