Provider Demographics
NPI:1861001455
Name:VITAL HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:VITAL HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-901-6009
Mailing Address - Street 1:9141 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1606
Mailing Address - Country:US
Mailing Address - Phone:630-901-6009
Mailing Address - Fax:630-333-4220
Practice Address - Street 1:9141 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1606
Practice Address - Country:US
Practice Address - Phone:630-901-6009
Practice Address - Fax:630-333-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health