Provider Demographics
NPI:1154882850
Name:VITALITY HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:VITALITY HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-240-6949
Mailing Address - Street 1:427 W COLORADO ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3044
Mailing Address - Country:US
Mailing Address - Phone:747-240-6949
Mailing Address - Fax:
Practice Address - Street 1:427 W COLORADO ST STE 105
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3044
Practice Address - Country:US
Practice Address - Phone:747-240-6949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1Medicaid