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Organization
VITAL SOURCE MINISTRY ENTERPRISE
Active
Organization
VITAL SOURCE MINISTRY ENTERPRISE
Active
Other names
VITAL SOURCE PROVIDERS
Organization subpart
No
Provider details
NPI number
Authorized official
DAMITA JOHNSON (ADMINISTRATOR)
(313) 492-9437
Entity
Organization
Contact information
Practice address
1401 W FORT ST UNIT 441846, DETROIT, MI 48244-3575
(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
251V00000X
Voluntary or Charitable Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
347C00000X
Private Vehicle
—
NULL
Other
Enumeration date
10/21/2024
Last updated
10/28/2024
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