| NPI | 1235950361 |
|---|---|
| Doing Business As | VITAL SOURCE PROVIDERS |
| Entity Type | Organization |
| Authorized Contact | DAMITA JOHNSON Administrator 313-492-9437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2024-10-28 |