Provider Demographics
NPI:1386246197
Name:VITALIZE BEHAVIORAL HEALTH AND PSYCHOMETRICS INC.
Entity type:Organization
Organization Name:VITALIZE BEHAVIORAL HEALTH AND PSYCHOMETRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:559-801-8944
Mailing Address - Street 1:13264 E SAGINAW WAY
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7265 N 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2956
Practice Address - Country:US
Practice Address - Phone:559-492-1560
Practice Address - Fax:559-234-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility