Organization
VITAL SOURCE HOME CARE PROVIDERS LLC
Active
Other names
DAMITA COLLETTE JOHNSON
Organization subpart
No
Provider details
NPI number
Authorized official
DAMITA COLLETTE JOHNSON (MANAGER)
(313) 492-9437
Entity
Organization
Contact information
Practice address
18945 FIELDING ST, DETROIT, MI 48219-2511
(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
101YP1600X
Pastoral Counselor
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
372600000X
Adult Companion
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
02/10/2025
Last updated
02/18/2025
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