Provider Demographics
NPI:1700637287
Name:VITA OF NEW WHITELAND
Entity Type:Organization
Organization Name:VITA OF NEW WHITELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE / SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-854-8800
Mailing Address - Street 1:2001 KILLEBREW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1884
Mailing Address - Country:US
Mailing Address - Phone:952-854-8800
Mailing Address - Fax:952-854-4434
Practice Address - Street 1:532 COUNTRY GATE DRIVE
Practice Address - Street 2:
Practice Address - City:NEW WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184
Practice Address - Country:US
Practice Address - Phone:317-463-7155
Practice Address - Fax:317-463-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility