# VITA HEALTH INITIATIVE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821683608
- **Authorized official:** DR. MAZVITA MAZIVEYI (OWNER)
- **Authorized official phone:** (504) 434-8476

## Contact information

- **Practice address:** 258 GREEN MEADOWS RD, WILMER, TX 75172-3335
- **Practice address phone:** (504) 434-8476
- **Mailing address:** 258 GREEN MEADOWS RD, WILMER, TX 75172-3335
- **Mailing address phone:** (504) 434-8476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 293D00000X | Physiological Laboratory | — | NULL | — |
| 302F00000X | Exclusive Provider Organization | — | NULL | — |
| 302R00000X | Health Maintenance Organization | — | NULL | — |
| 305R00000X | Preferred Provider Organization | — | NULL | — |
| 305S00000X | Point of Service | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/04/2021
- **Last updated:** 07/12/2022