NPIMap

Organization Active NPI

Vita Health Care S.C.

  • Home Health Agency
  • Northbrook, IL
National Provider Identifier
1790113496
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
VITA HEALTH CARE S.C.
Practice address
342 Anthony TRL
Northbrook, IL 60062-2014
Phone
(877) 968-6388
Fax
(877) 968-3266
NPI assigned
Oct 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Authorized official

Name
Marya Serdyukova, LCSW, MPHNPI 1912690991
Title
Administrator
Phone
(877) 968-6388

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X IL Primary
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

342 Anthony TRL
Northbrook, IL 60062-2014

Mailing address

342 Anthony TRL
Northbrook, IL 60062-2014
Phone (877) 968-6388

Other identifiers 1

IdentifierTypeStateIssuer
1011722OtherILILLINOIS STATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140109001313 IL Part A Provider - Home Health Agency 7012145402 Practice locations: Northbrook, IL

Home health agency certification: CCN 148153

Legal name
VITA HEALTH CARE S.C.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 10, 2010
Last certification
Jun 10, 2010
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Nov 27, 2012 in IL
Enrollment address
342 Anthony Trail
Northbrook, IL 60062-2014

Care Compare: Home health agency

Medicare Care Compare
Listed as
Vita Health Care, IncCCN 148153 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Jun 10, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2068491Vita Health Care Inc342 Anthony Trail, Northbrook, IL 60062Certificate of waiverNov 4, 2027

National Provider Directory

National Provider Directory

Locations

342 Anthony Trl
Northbrook, IL 60062
Phone (224) 235-4327

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marya Serdyukova Individual 5% Or Greater Direct Ownership Interest Nov 27, 2012 51%
Corporate OfficerPresident Nov 27, 2012 51%
Corporate DirectorBoard Member Nov 27, 2012 51%
W-2 Managing EmployeePresident, Administrator Nov 27, 2012 51%
Operational/Managerial ControlPresident, Secretary, Treasurer Nov 27, 2012 51%
Marianna Pokotylo Individual 5% Or Greater Direct Ownership InterestVice President Jan 1, 2020 49%
Corporate OfficerVice President Jan 1, 2020 49%
Corporate DirectorBoard Member Jan 1, 2020 49%
W-2 Managing EmployeeVice President Jan 1, 2020 49%
Operational/Managerial ControlVice President, Director of Nursing Jan 1, 2020 49%

Practitioners & affiliated clinicians

Practitioners 1

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

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1790113496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 ANTHONY TRL",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600622014",
            "telephone_number": "877-968-6388",
            "fax_number": "877-968-3266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 ANTHONY TRL",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600622014",
            "telephone_number": "877-968-6388",
            "fax_number": "877-968-3266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITA HEALTH CARE S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "SERDYUKOVA",
        "authorized_official_first_name": "MARYA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "877-968-6388",
        "authorized_official_credential": "LCSW, MPH"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS STATE LICENSE",
            "identifier": "1011722",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northbrook, IL

Sources for this page

Verify at the official NPI Registry.