Provider Demographics
NPI:1548978059
Name:TH VEGA BEHAVIORAL CORP
Entity type:Organization
Organization Name:TH VEGA BEHAVIORAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ DE LA GUARDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-410-8439
Mailing Address - Street 1:10876 SW 229TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7517
Mailing Address - Country:US
Mailing Address - Phone:786-370-2216
Mailing Address - Fax:
Practice Address - Street 1:100 NE 15TH ST STE 101A
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4564
Practice Address - Country:US
Practice Address - Phone:786-547-7103
Practice Address - Fax:786-601-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty