Provider Demographics
NPI:1881245314
Name:VITALISCARE CLINIC LLC
Entity type:Organization
Organization Name:VITALISCARE CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORDAS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:224-713-0003
Mailing Address - Street 1:1212 E ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5446
Mailing Address - Country:US
Mailing Address - Phone:224-713-0003
Mailing Address - Fax:224-678-7122
Practice Address - Street 1:1212 E ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5446
Practice Address - Country:US
Practice Address - Phone:224-713-0003
Practice Address - Fax:224-678-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty