Provider Demographics
NPI:1962405977
Name:VITAL AMBULATORY HEALTHCARE,INC
Entity type:Organization
Organization Name:VITAL AMBULATORY HEALTHCARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:IJEOMA
Authorized Official - Last Name:NWABEKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-270-6995
Mailing Address - Street 1:6666 HARWIN DR
Mailing Address - Street 2:STE 350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2261
Mailing Address - Country:US
Mailing Address - Phone:712-270-6995
Mailing Address - Fax:713-270-0334
Practice Address - Street 1:6666 HARWIN DR
Practice Address - Street 2:STE 350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2261
Practice Address - Country:US
Practice Address - Phone:712-270-6995
Practice Address - Fax:713-270-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459006Medicare ID - Type Unspecified