Provider Demographics
NPI:1578308938
Name:VITALIZE HEALTH COMMUNITY MENTAL CORP.
Entity type:Organization
Organization Name:VITALIZE HEALTH COMMUNITY MENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-660-0283
Mailing Address - Street 1:14221 SW 120TH ST STE 218
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4225
Mailing Address - Country:US
Mailing Address - Phone:786-542-5184
Mailing Address - Fax:
Practice Address - Street 1:14221 SW 120TH ST STE 218
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4225
Practice Address - Country:US
Practice Address - Phone:786-542-5184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine