Provider Demographics
NPI:1811572209
Name:VITAL HOMECARE LLC.
Entity type:Organization
Organization Name:VITAL HOMECARE LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY-ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-982-8431
Mailing Address - Street 1:41 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-2411
Mailing Address - Country:US
Mailing Address - Phone:203-982-8431
Mailing Address - Fax:
Practice Address - Street 1:41 COURTLAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2411
Practice Address - Country:US
Practice Address - Phone:203-982-8431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care