# WELLWARD VITALITY SUPPORT SERVICES

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

## Provider details

- **NPI number:** 1902724255
- **Authorized official:** JUSTIN CHISHOLM (OWNER/ MANAGING MEMBER)
- **Authorized official phone:** (267) 694-0617

## Contact information

- **Practice address:** 223 E MAIN ST, LANSDALE, PA 19446-2520
- **Practice address phone:** (267) 694-0617
- **Mailing address:** 223 E MAIN ST, LANSDALE, PA 19446-2520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 07/06/2026
- **Last updated:** 07/06/2026