NPIMap

Organization Active NPI

Vital Source Ministry Enterprise

  • In Home Supportive Care Agency
  • Detroit, MI
National Provider Identifier
1235950361
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
VITAL SOURCE MINISTRY ENTERPRISE
Practice address
1401 W Fort St Unit 441846
Detroit, MI 48244-3575
Phone
(313) 492-9437
NPI assigned
Oct 21, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Damita JohnsonNPI 1851139620
Title
Administrator
Phone
(313) 492-9437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Voluntary or Charitable Agency 251V00000X
In Home Supportive Care Agency 253Z00000X Primary
Private Vehicle 347C00000X

Addresses

Primary practice location

1401 W Fort St Unit 441846
Detroit, MI 48244-3575

Mailing address

1401 W Fort St Unit 441846
Detroit, MI 48244-3575
Phone (313) 492-9437

Other names 1

  • VITAL SOURCE PROVIDERS Doing business as

National Provider Directory

National Provider Directory

Locations

1401 W Fort St
Unit 441846
Detroit, MI 48244
Phone (313) 492-9437

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1235950361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 W FORT ST UNIT 441846",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482443575",
            "telephone_number": "313-492-9437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W FORT ST UNIT 441846",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482443575",
            "telephone_number": "313-492-9437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL SOURCE MINISTRY ENTERPRISE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-21",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAMITA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "313-492-9437"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VITAL SOURCE PROVIDERS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.