Provider Demographics
NPI:1689834228
Name:VWELLWEST, INC.
Entity Type:Organization
Organization Name:VWELLWEST, INC.
Other - Org Name:VITAL WELLNESS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PANALIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:630-742-5608
Mailing Address - Street 1:10451 W PALMERAS DR
Mailing Address - Street 2:SUITE 237W
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-2011
Mailing Address - Country:US
Mailing Address - Phone:623-933-1896
Mailing Address - Fax:623-933-4015
Practice Address - Street 1:10451 W. PALMERAS DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-933-1896
Practice Address - Fax:623-933-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4404251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03-7278OtherMEDICARE PTAN