Provider Demographics
NPI:1063736197
Name:VIVALIFE, INC.
Entity type:Organization
Organization Name:VIVALIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOUTHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-709-7912
Mailing Address - Street 1:1830 NW 7TH ST
Mailing Address - Street 2:#218
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3569
Mailing Address - Country:US
Mailing Address - Phone:786-360-5655
Mailing Address - Fax:786-360-5372
Practice Address - Street 1:1830 NW 7TH ST
Practice Address - Street 2:#218
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3569
Practice Address - Country:US
Practice Address - Phone:786-360-5655
Practice Address - Fax:786-360-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1183251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health