Provider Demographics
NPI:1265713960
Name:VITACARE, LLC
Entity type:Organization
Organization Name:VITACARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ROYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-233-6502
Mailing Address - Street 1:2417 N. VAN BUREN
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703
Mailing Address - Country:US
Mailing Address - Phone:580-233-6502
Mailing Address - Fax:580-233-6521
Practice Address - Street 1:3209 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1035
Practice Address - Country:US
Practice Address - Phone:580-765-8159
Practice Address - Fax:580-765-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies