Provider Demographics
NPI:1366717951
Name:VITAL WELLNESS LLC
Entity type:Organization
Organization Name:VITAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PANALIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-369-8450
Mailing Address - Street 1:651 AMERSALE DR
Mailing Address - Street 2:105
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2587
Mailing Address - Country:US
Mailing Address - Phone:630-369-8450
Mailing Address - Fax:
Practice Address - Street 1:6860 S YOSEMITE CT
Practice Address - Street 2:2000
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1409
Practice Address - Country:US
Practice Address - Phone:630-369-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20111674892251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health