Provider Demographics
NPI:1912413386
Name:VITALIZING CARE CONSULTANTS LLC
Entity Type:Organization
Organization Name:VITALIZING CARE CONSULTANTS LLC
Other - Org Name:VITALIZING CARE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHOMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:855-455-2274
Mailing Address - Street 1:PO BOX 180266
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48318-0266
Mailing Address - Country:US
Mailing Address - Phone:855-455-2274
Mailing Address - Fax:
Practice Address - Street 1:1420 WASHINGTON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226
Practice Address - Country:US
Practice Address - Phone:855-455-2274
Practice Address - Fax:586-314-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2022-01-12
Deactivation Date:2021-12-21
Deactivation Code:
Reactivation Date:2022-01-12
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 104100000X, 163WC0400X, 163WH0200X, 171M00000X, 172V00000X, 174H00000X, 208100000X, 372600000X, 374U00000X, 171W00000X, 171WH0202X, 172V00000X
MI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty