Provider Demographics
NPI:1821683608
Name:VITA HEALTH INITIATIVE LLC
Entity Type:Organization
Organization Name:VITA HEALTH INITIATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZIVEYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-434-8476
Mailing Address - Street 1:258 GREEN MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:WILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75172-3335
Mailing Address - Country:US
Mailing Address - Phone:504-434-8476
Mailing Address - Fax:
Practice Address - Street 1:258 GREEN MEADOWS RD
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:TX
Practice Address - Zip Code:75172-3335
Practice Address - Country:US
Practice Address - Phone:504-434-8476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No293D00000XLaboratoriesPhysiological Laboratory
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service