Provider Demographics
NPI:1902372410
Name:VITURO HEALTH OF LAS VEGAS, LLC
Entity Type:Organization
Organization Name:VITURO HEALTH OF LAS VEGAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-515-5401
Mailing Address - Street 1:2901 2ND AVE S STE 130
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2928
Mailing Address - Country:US
Mailing Address - Phone:866-484-8876
Mailing Address - Fax:941-296-8210
Practice Address - Street 1:2901 2ND AVE S STE 130
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2928
Practice Address - Country:US
Practice Address - Phone:866-484-8876
Practice Address - Fax:941-296-8210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITURO HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty