Provider Demographics
NPI:1740006451
Name:VITALCARE HEALTH HOME
Entity type:Organization
Organization Name:VITALCARE HEALTH HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-426-7773
Mailing Address - Street 1:27 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2826
Mailing Address - Country:US
Mailing Address - Phone:347-426-7773
Mailing Address - Fax:
Practice Address - Street 1:17567 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5724
Practice Address - Country:US
Practice Address - Phone:718-424-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management