Healthcare Provider Details

I. General information

NPI: 1578308938
Provider Name (Legal Business Name): VITALIZE HEALTH COMMUNITY MENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 SW 8TH ST STE 2E
WEST MIAMI FL
33144-4858
US

IV. Provider business mailing address

6355 SW 8TH ST STE 2E
WEST MIAMI FL
33144-4858
US

V. Phone/Fax

Practice location:
  • Phone: 786-660-0283
  • Fax:
Mailing address:
  • Phone: 786-660-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER RIVERO RIVERO
Title or Position: PRESIDENT
Credential:
Phone: 786-660-0283