Vital Agency LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

VITAL AGENCY LLC

Practice address

12864 Fillmore Street NE
Blaine, MN 55434

Phone

(612) 275-3889

NPI assigned

Apr 19, 2019

Organization subpart

No

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

Authorized official

Name

Nambago Kalema

Title

Ceo

Phone

(612) 275-3889

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555632000000",
    "number": "1932762408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12864 FILLMORE STREET NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "55434",
            "telephone_number": "612-275-3889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12864 FILLMORE STREET NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "55434",
            "telephone_number": "612-275-3889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-19",
        "last_updated": "2019-04-19",
        "status": "A",
        "authorized_official_last_name": "KALEMA",
        "authorized_official_first_name": "NAMBAGO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-275-3889"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2019; 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.