Provider Demographics
NPI:1952068843
Name:VITAL HEALTH LLC
Entity Type:Organization
Organization Name:VITAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPELLIS-FREYRE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:419-740-3022
Mailing Address - Street 1:111 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2811
Mailing Address - Country:US
Mailing Address - Phone:419-740-3022
Mailing Address - Fax:419-740-3033
Practice Address - Street 1:111 CLINTON ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2811
Practice Address - Country:US
Practice Address - Phone:197-403-0224
Practice Address - Fax:419-740-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health