Provider Demographics
NPI:1548995962
Name:VITALITY SPRING RESORT ALF LLC
Entity type:Organization
Organization Name:VITALITY SPRING RESORT ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DORVAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:772-940-9219
Mailing Address - Street 1:11380 SW HILLCREST CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2704
Mailing Address - Country:US
Mailing Address - Phone:772-940-9219
Mailing Address - Fax:772-408-0969
Practice Address - Street 1:121 SW OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4934
Practice Address - Country:US
Practice Address - Phone:772-207-7947
Practice Address - Fax:772-408-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty