1528216496 NPI number — VITAL CARE HOME HEALTH

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 1528216496 NPI number — VITAL CARE HOME HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL CARE HOME HEALTH
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:
1528216496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2130 N ARROWHEAD AVE
Provider Second Line Business Mailing Address:
SUITE 103C
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92405-4023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-882-0101
Provider Business Mailing Address Fax Number:
909-882-0202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2130 N ARROWHEAD AVE
Provider Second Line Business Practice Location Address:
SUITE 103C
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92405-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-882-0101
Provider Business Practice Location Address Fax Number:
909-882-0202
Provider Enumeration Date:
09/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FARROW
Authorized Official First Name:
OTIS
Authorized Official Middle Name:
DARNELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-882-0101

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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