Organization
VITAL WELLNESS HEALTHCARE, INC.
Active
Other names
Vital Wellness Home Health, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
ALLAN DENNIS ROSALES (CLINICAL OPERATION EXECUTIVE)
(312) 989-9260
Entity
Organization
Contact information
Practice address
2621 MONTEGA DR STE E, SPRINGFIELD, IL 62704
(217) 717-1909
(217) 717-1957
Mailing address
1717 HOWARD ST, EVANSTON, IL 60202-3735
(630) 369-8450
(630) 369-6984
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010318
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982686861-001
—
IL
Enumeration date
11/16/2005
Last updated
10/03/2018
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