Provider Demographics
NPI:1255174777
Name:VITALITY HOME THERAPIES, INC.
Entity type:Organization
Organization Name:VITALITY HOME THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:630-615-0668
Mailing Address - Street 1:1815 WALLACE AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3421
Mailing Address - Country:US
Mailing Address - Phone:630-615-0668
Mailing Address - Fax:
Practice Address - Street 1:33 W HIGGINS RD STE 4100
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9123
Practice Address - Country:US
Practice Address - Phone:630-615-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment