Provider Demographics
NPI:1104483098
Name:VITALITY HEALTH CENTER LLC
Entity type:Organization
Organization Name:VITALITY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLABA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN PMHNP FNP CRNA
Authorized Official - Phone:877-393-2492
Mailing Address - Street 1:10111 E 21ST ST N STE 315
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3581
Mailing Address - Country:US
Mailing Address - Phone:877-393-2492
Mailing Address - Fax:316-854-5194
Practice Address - Street 1:10111 E 21ST ST N STE 315
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3581
Practice Address - Country:US
Practice Address - Phone:877-393-2492
Practice Address - Fax:316-680-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-25
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty