Provider Demographics
NPI:1902620735
Name:REVITALIZE CARE CENTER INC
Entity type:Organization
Organization Name:REVITALIZE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIADNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-636-8084
Mailing Address - Street 1:850 NW 42ND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4168
Mailing Address - Country:US
Mailing Address - Phone:786-636-8084
Mailing Address - Fax:
Practice Address - Street 1:850 NW 42ND AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4168
Practice Address - Country:US
Practice Address - Phone:786-636-8084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center