Provider Demographics
NPI:1912467788
Name:VITAL SKILLS CENTER LLC
Entity Type:Organization
Organization Name:VITAL SKILLS CENTER LLC
Other - Org Name:ANN MARIE WANLISS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ITDS, BCBA
Authorized Official - Phone:954-652-8613
Mailing Address - Street 1:9376 NW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7788
Mailing Address - Country:US
Mailing Address - Phone:954-652-8613
Mailing Address - Fax:
Practice Address - Street 1:4117 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6005
Practice Address - Country:US
Practice Address - Phone:954-652-8613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITAL SKILLS CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-20
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty