Provider Demographics
NPI:1922571983
Name:VITAL HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:VITAL HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTATIVE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYEMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-866-6493
Mailing Address - Street 1:9304 FOREST LN STE N265
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9304 FOREST LN STE N265
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6238
Practice Address - Country:US
Practice Address - Phone:972-861-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health