Provider Demographics
NPI:1942891320
Name:VALE COMMUNITY WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:VALE COMMUNITY WELLNESS CENTER LLC
Other - Org Name:VALE COMMUNITY WELLNESS CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIDYS
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-609-8737
Mailing Address - Street 1:14221 SW 120TH ST STE 123
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7463
Mailing Address - Country:US
Mailing Address - Phone:786-609-8737
Mailing Address - Fax:786-306-7952
Practice Address - Street 1:14221 SW 120TH ST STE 123
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7463
Practice Address - Country:US
Practice Address - Phone:786-609-8737
Practice Address - Fax:786-306-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR362-536-86-887-1Medicaid