- Enrollment id
- O20100614000497
- Enrollment state
- FL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1548346828
- Multiple npi flag
- N
- Ccn
- 108323
- Associate id
- 6002836707
- Organization name
- VITAL HEALTH SERVICES, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 8600 NW SOUTH RIVER DR
- Address line 2
- STE 99
- City
- MEDLEY
- State
- FL
- Zip code
- 331667448