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
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
10/21/2024
Last updated
10/28/2024
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