Provider Demographics
NPI:1982386579
Name:VITALIZE AMBIANCE LLC
Entity Type:Organization
Organization Name:VITALIZE AMBIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:ITDS, CBD
Authorized Official - Phone:561-298-4985
Mailing Address - Street 1:631 LUCERNE AVE STE SUITE66
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3820
Mailing Address - Country:US
Mailing Address - Phone:561-298-4985
Mailing Address - Fax:
Practice Address - Street 1:631 LUCERNE AVE STE SUITE66
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3820
Practice Address - Country:US
Practice Address - Phone:561-298-4985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty