Provider Demographics
NPI:1871883611
Name:VITAS HEALTHCARE CORPORATION MIDWEST
Entity type:Organization
Organization Name:VITAS HEALTHCARE CORPORATION MIDWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-350-6756
Mailing Address - Street 1:3046 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6547
Mailing Address - Country:US
Mailing Address - Phone:305-350-5930
Mailing Address - Fax:305-350-6993
Practice Address - Street 1:2215 DECATUR HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2360
Practice Address - Country:US
Practice Address - Phone:205-502-5959
Practice Address - Fax:205-502-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALE3725251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1637EMedicaid
ALPIC1637EMedicaid