Provider Demographics
NPI:1144914011
Name:VITALITY CARE LLC
Entity type:Organization
Organization Name:VITALITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFAYDEN-KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:RMA, CNA
Authorized Official - Phone:678-215-4591
Mailing Address - Street 1:285 W WIEUCA RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3321
Mailing Address - Country:US
Mailing Address - Phone:404-902-9961
Mailing Address - Fax:
Practice Address - Street 1:4518 ASH TREE ST
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3361
Practice Address - Country:US
Practice Address - Phone:404-902-9961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health