Provider Demographics
NPI:1437949963
Name:VITAL HEALTH DIAGNOSTICS & SUPPLIES
Entity type:Organization
Organization Name:VITAL HEALTH DIAGNOSTICS & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RRT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:253-441-1071
Mailing Address - Street 1:3203 LAGO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8793
Mailing Address - Country:US
Mailing Address - Phone:253-441-1071
Mailing Address - Fax:
Practice Address - Street 1:3203 LAGO VISTA DR
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-8793
Practice Address - Country:US
Practice Address - Phone:253-441-1071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies