Provider Demographics
NPI:1194442020
Name:VITA OF MARION LLC
Entity type:Organization
Organization Name:VITA OF MARION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE ACCOUNTING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:779-771-6982
Mailing Address - Street 1:4211 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5067
Mailing Address - Country:US
Mailing Address - Phone:765-303-2056
Mailing Address - Fax:
Practice Address - Street 1:4211 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5067
Practice Address - Country:US
Practice Address - Phone:765-303-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility