Vital Wellness Healthcare, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1010318 Issued in IL

Legal business name

VITAL WELLNESS HEALTHCARE, INC.

Practice address

2621 Montega Dr Ste E
Springfield, IL 62704

Phone

(217) 717-1909

Fax

(217) 717-1957

NPI assigned

Nov 16, 2005

Reactivated

Oct 3, 2018

Last updated

Oct 3, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Allan Dennis Rosales

Title

Clinical Operation Executive

Phone

(312) 989-9260

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vital Wellness Home Health, Inc. Former legal business name

Locations

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538524800000",
    "number": "1982686861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 HOWARD ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023735",
            "telephone_number": "630-369-8450",
            "fax_number": "630-369-6984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 MONTEGA DR STE E",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62704",
            "telephone_number": "217-717-1909",
            "fax_number": "217-717-1957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL WELLNESS HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2018-10-03",
        "deactivation_date": "2018-09-04",
        "reactivation_date": "2018-10-03",
        "status": "A",
        "authorized_official_last_name": "ROSALES",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "DENNIS",
        "authorized_official_title_or_position": "CLINICAL OPERATION EXECUTIVE",
        "authorized_official_telephone_number": "312-989-9260"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1010318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982686861-001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vital Wellness Home Health, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Visions LLC
• Patricia M Visnesky, M.D.
• Avinash Kashyap Viswanathan, M.D.
• Vital Life Lab Services LLC
• Vital Wellness Healthcare, Inc.
• Vital Wellness Home Health Inc.
• Maria Cristina Viteri Quincha, MD
• Molly-Jean Vits
• Korine G Vlahos, M.D.
• Shauna Vogler, NP-C

• Home Health Agency in Springfield, IL
• Providers in Springfield, IL by specialty
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; 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.