Provider Demographics
NPI:1528050846
Name:VITAL HOME HEALTH CARE, INC
Entity type:Organization
Organization Name:VITAL HOME HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:V
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-432-6650
Mailing Address - Street 1:2500 E FOOTHILL BLVD
Mailing Address - Street 2:STE. 501
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3464
Mailing Address - Country:US
Mailing Address - Phone:626-432-6650
Mailing Address - Fax:626-432-6653
Practice Address - Street 1:2500 E FOOTHILL BLVD
Practice Address - Street 2:STE. 501
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3464
Practice Address - Country:US
Practice Address - Phone:626-432-6650
Practice Address - Fax:626-432-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57423FMedicaid
CAHHA57423FMedicaid