Healthcare Provider Details

I. General information

NPI: 1679894422
Provider Name (Legal Business Name): ALIVIANE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10690 SOCORRO RD
EL PASO TX
79927-2332
US

IV. Provider business mailing address

PO BOX 371710
EL PASO TX
79937-1710
US

V. Phone/Fax

Practice location:
  • Phone: 915-858-6208
  • Fax: 915-858-0435
Mailing address:
  • Phone: 915-775-4638
  • Fax: 915-778-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number402B
License Number StateTX

VIII. Authorized Official

Name: MS. IVONNE TAPIA
Title or Position: CEO
Credential:
Phone: 915-782-4000