Provider Demographics
NPI:1912445073
Name:VITALITY UNLIMITED
Entity type:Organization
Organization Name:VITALITY UNLIMITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA
Authorized Official - Phone:775-738-4158
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-2580
Mailing Address - Country:US
Mailing Address - Phone:775-738-4158
Mailing Address - Fax:
Practice Address - Street 1:215 BLUFFS AVE STE 200
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2465
Practice Address - Country:US
Practice Address - Phone:775-738-8004
Practice Address - Fax:775-753-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376624494Medicaid