Provider Demographics
NPI:1861263519
Name:VITALVOYAGELLC
Entity type:Organization
Organization Name:VITALVOYAGELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DIARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-446-3770
Mailing Address - Street 1:2726 WINDON DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-4645
Mailing Address - Country:US
Mailing Address - Phone:716-446-3770
Mailing Address - Fax:
Practice Address - Street 1:2726 WINDON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-4645
Practice Address - Country:US
Practice Address - Phone:716-446-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)