Provider Demographics
NPI:1699214569
Name:VITALIS HOME HEALTH LLC
Entity Type:Organization
Organization Name:VITALIS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:O
Authorized Official - Last Name:ARREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-390-6884
Mailing Address - Street 1:9821 SUMMERWOOD CIR APT 1308
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7742
Mailing Address - Country:US
Mailing Address - Phone:202-390-6884
Mailing Address - Fax:972-476-0870
Practice Address - Street 1:9821 SUMMERWOOD CIR APT 1308
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:202-390-6884
Practice Address - Fax:972-476-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015415251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health