Provider Demographics
NPI:1700979291
Name:VITAL HEALTHCARE, LLC.
Entity Type:Organization
Organization Name:VITAL HEALTHCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SYGACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-908-9360
Mailing Address - Street 1:5936 W. MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1628
Mailing Address - Country:US
Mailing Address - Phone:773-326-6848
Mailing Address - Fax:773-202-0208
Practice Address - Street 1:5936 W. MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1628
Practice Address - Country:US
Practice Address - Phone:773-326-6848
Practice Address - Fax:773-202-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010487163WH0200X
IL1616835251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Not Answered251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010487OtherPUBLIC HEALTH LICENSE