Provider Demographics
NPI:1336144799
Name:VITACARE, INC.
Entity type:Organization
Organization Name:VITACARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAERTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-752-5900
Mailing Address - Street 1:930 W COMMERCE ST
Mailing Address - Street 2:PO BOX 224785
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-4785
Mailing Address - Country:US
Mailing Address - Phone:214-752-5900
Mailing Address - Fax:214-752-5900
Practice Address - Street 1:930 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-752-5900
Practice Address - Fax:214-752-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0012126332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010013301Medicaid