Provider Demographics
NPI:1174395677
Name:VITAL SPRINGS HEALTH SYSTEMS LLC
Entity type:Organization
Organization Name:VITAL SPRINGS HEALTH SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MACEO
Authorized Official - Middle Name:
Authorized Official - Last Name:SMEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-201-1381
Mailing Address - Street 1:1218 MAGNOLIA DALE DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-9680
Mailing Address - Country:US
Mailing Address - Phone:979-201-1381
Mailing Address - Fax:
Practice Address - Street 1:12125 HWY 6
Practice Address - Street 2:UNITS E
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545
Practice Address - Country:US
Practice Address - Phone:979-201-1381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No251B00000XAgenciesCase Management