Provider Demographics
NPI:1205434297
Name:VITAL FOUNDATIONS
Entity type:Organization
Organization Name:VITAL FOUNDATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS
Authorized Official - Phone:682-233-2336
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-0146
Mailing Address - Country:US
Mailing Address - Phone:682-233-2336
Mailing Address - Fax:
Practice Address - Street 1:8637 TRIBUTE LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-3385
Practice Address - Country:US
Practice Address - Phone:682-233-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service