MEDICARE: VITALIZE HEALTH COMMUNITY MENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578308938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALIZE HEALTH COMMUNITY MENTAL CORP

Provider Business Mailing Address
First Line	:	6355 SW 8TH ST STE 2E
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-4858
Country	:	US
Telephone Number	:	786-660-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	6355 SW 8TH ST STE 2E
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-4858
Country	:	US
Telephone Number	:	786-660-0283
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JENNIFER RIVERO RIVERO
Credential	:
Telephone Number	:	786-660-0283

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	04/13/2026

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