Healthcare Provider Details

I. General information

NPI: 1417869983
Provider Name (Legal Business Name): AVIVIAN COMMUNITY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4094 W ADAMS CIR
HAMMONTON NJ
08037-1061
US

IV. Provider business mailing address

320 VANDERBILT AVE APT 3T
STATEN ISLAND NY
10304-3563
US

V. Phone/Fax

Practice location:
  • Phone: 347-265-5482
  • Fax:
Mailing address:
  • Phone: 347-265-5482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZA KOLLIE
Title or Position: MANAGING MEMBER
Credential: RN, BSN
Phone: 347-265-5482