Organization
VITALIZE HEALTHCARE LTD. CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON EUGENE SIMS (MANAGER)
(252) 315-5165
Entity
Organization
Contact information
Practice address
386 WALLER AVE STE 103-104, LEXINGTON, KY 40504-2917
(252) 315-5165
Mailing address
386 WALLER AVE STE 103-104, LEXINGTON, KY 40504-2917
(252) 315-5165
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1
—
KY
Enumeration date
01/10/2017
Last updated
01/10/2017
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