Provider Demographics
NPI:1457920647
Name:VITALITY HEALTH LLC
Entity Type:Organization
Organization Name:VITALITY HEALTH LLC
Other - Org Name:VITALITY HEALTH LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAHIMAH
Authorized Official - Middle Name:BEN-ASAD
Authorized Official - Last Name:RAY-EL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-809-3119
Mailing Address - Street 1:20905 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5360
Mailing Address - Country:US
Mailing Address - Phone:248-809-3119
Mailing Address - Fax:
Practice Address - Street 1:20905 GREENFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5346
Practice Address - Country:US
Practice Address - Phone:248-809-3119
Practice Address - Fax:248-996-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty