1366303976 NPI number — VITACORE CARE SOLUTIONS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366303976 NPI number — VITACORE CARE SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITACORE CARE SOLUTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366303976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10108 GLEN EDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46774-7411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-908-5128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16827 KELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTERTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46748-9715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-908-5128
Provider Business Practice Location Address Fax Number:
260-908-5128
Provider Enumeration Date:
11/21/2025

Additional Information

Authorized Official

Authorized Official Last Name:
KELL
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
260-908-5128

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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