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Organization
VITAL SOURCE HOME CARE PROVIDERS LLC
Active
Organization
VITAL SOURCE HOME CARE PROVIDERS LLC
Active
Other names
DAMITA COLLETTE JOHNSON
Organization subpart
No
Provider details
NPI number
Authorized official
DAMITA COLLETTE JOHNSON (MANAGER)
(313) 492-9437
Entity
Organization
Contact information
Practice address
18945 FIELDING ST, DETROIT, MI 48219-2511
(313) 492-9437
Mailing address
1401 W FORT ST UNIT 441846, DETROIT, MI 48244-3575
(313) 492-9437
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
NULL
101YP1600X
Pastoral Counselor
—
—
251E00000X
Home Health Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
343900000X
Non-emergency Medical Transport (VAN)
—
NULL
347C00000X
Private Vehicle
—
NULL
372600000X
Adult Companion
Primary
—
NULL
372600000X
Adult Companion
Primary
—
—
374U00000X
Home Health Aide
—
NULL
374U00000X
Home Health Aide
—
—
Other
Enumeration date
02/10/2025
Last updated
02/18/2025
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