Provider Demographics
NPI:1760210173
Name:VITAL RESTORATIVE CARE LLC
Entity type:Organization
Organization Name:VITAL RESTORATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAHRA MAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KATO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-633-2369
Mailing Address - Street 1:8880 W SUNSET RD STE 175
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5004
Mailing Address - Country:US
Mailing Address - Phone:702-463-8548
Mailing Address - Fax:
Practice Address - Street 1:8880 W SUNSET RD STE 175
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5004
Practice Address - Country:US
Practice Address - Phone:702-463-8548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty