Provider Demographics
NPI:1700131547
Name:VITAL WELLNESS CORPORATION
Entity Type:Organization
Organization Name:VITAL WELLNESS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-272-6292
Mailing Address - Street 1:1717 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3735
Mailing Address - Country:US
Mailing Address - Phone:312-989-9260
Mailing Address - Fax:773-345-4637
Practice Address - Street 1:7853 E ARAPAHOE CT
Practice Address - Street 2:SUITE 1100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:630-369-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20111674892251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health