Provider Demographics
NPI:1356342216
Name:VITAL CARE WELLNESS, LLC
Entity type:Organization
Organization Name:VITAL CARE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-544-0200
Mailing Address - Street 1:19082 N RH JOHNSON BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4482
Mailing Address - Country:US
Mailing Address - Phone:623-544-0300
Mailing Address - Fax:623-544-0239
Practice Address - Street 1:19082 N RH JOHNSON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4482
Practice Address - Country:US
Practice Address - Phone:623-544-0300
Practice Address - Fax:623-544-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty