# VITAL SOURCE HOME CARE PROVIDERS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** DAMITA COLLETTE JOHNSON
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124833900
- **Authorized official:** DAMITA COLLETTE JOHNSON (MANAGER)
- **Authorized official phone:** (313) 492-9437

## Contact information

- **Practice address:** 18945 FIELDING ST, DETROIT, MI 48219-2511
- **Practice address phone:** (313) 492-9437
- **Mailing address:** 1401 W FORT ST UNIT 441846, DETROIT, MI 48244-3575
- **Mailing address phone:** (313) 492-9437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 372600000X | Adult Companion | — | — | Yes |
| 374U00000X | Home Health Aide | — | NULL | — |
| 374U00000X | Home Health Aide | — | — | — |

## Other

- **Enumeration date:** 02/10/2025
- **Last updated:** 02/18/2025