# VITALITYHOME HEALTHCARE, LLC

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

## Provider details

- **NPI number:** 1962974352
- **Authorized official:** ROY AGUILA (DIRECTOR)
- **Authorized official phone:** (847) 346-9907

## Contact information

- **Practice address:** 4123 FOUNTAINSIDE LN, FAIRFAX, VA 22030-7402
- **Practice address phone:** (847) 346-9913
- **Mailing address:** 4123 FOUNTAINSIDE LN, FAIRFAX, VA 22030-7402
- **Mailing address phone:** (847) 346-9913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 12/22/2018
- **Last updated:** 12/22/2018