Provider Demographics
NPI:1659161420
Name:VITAL HEALTHCARE LLC
Entity type:Organization
Organization Name:VITAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LISE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-460-4555
Mailing Address - Street 1:19533 HIGHLAND OAKS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9639
Mailing Address - Country:US
Mailing Address - Phone:239-241-6484
Mailing Address - Fax:
Practice Address - Street 1:19533 HIGHLAND OAKS DR STE 120
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9639
Practice Address - Country:US
Practice Address - Phone:239-241-6484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty