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Organization

VITA HEALTH INITIATIVE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MAZVITA MAZIVEYI (OWNER)
(504) 434-8476
Entity
Organization

Contact information

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

Taxonomy

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

Other

Enumeration date
03/04/2021
Last updated
07/12/2022
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