Provider Demographics
NPI:1205079985
Name:VITALITY HEALTHCARE INC
Entity type:Organization
Organization Name:VITALITY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AGENCY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JESUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASINABO-GARDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-378-8102
Mailing Address - Street 1:2025 S ARLINGTON HEIGHTS RD STE 113
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4141
Mailing Address - Country:US
Mailing Address - Phone:847-378-8102
Mailing Address - Fax:847-258-5156
Practice Address - Street 1:2025 S ARLINGTON HEIGHTS RD STE 113
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4141
Practice Address - Country:US
Practice Address - Phone:847-378-8102
Practice Address - Fax:847-258-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-11
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1921571251E00000X
IL1011732251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010963OtherSTATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH