Provider Demographics
NPI: | 1306230834 |
---|---|
Name: | VITRUVIAN HEALTHCARE SOLUTIONS, LLC |
Entity type: | Organization |
Organization Name: | VITRUVIAN HEALTHCARE SOLUTIONS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PHYSICIAN |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PRESTON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOWERTON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 816-645-5643 |
Mailing Address - Street 1: | 1741 NE BLUE HERON CT |
Mailing Address - Street 2: | |
Mailing Address - City: | LEES SUMMIT |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64086-7820 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 816-645-5643 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1741 NE BLUE HERON CT |
Practice Address - Street 2: | |
Practice Address - City: | LEES SUMMIT |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64086-7820 |
Practice Address - Country: | US |
Practice Address - Phone: | 816-645-5643 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-03-23 |
Last Update Date: | 2015-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 2005029307 | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |