Provider Demographics
NPI:1770457533
Name:VITALGUARD LLC
Entity type:Organization
Organization Name:VITALGUARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-250-3579
Mailing Address - Street 1:25463 HAWKS RUN LN
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-7736
Mailing Address - Country:US
Mailing Address - Phone:978-698-4825
Mailing Address - Fax:
Practice Address - Street 1:25463 HAWKS RUN LN
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-7736
Practice Address - Country:US
Practice Address - Phone:978-698-4825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder