Healthcare Provider Details

I. General information

NPI: 1992628556
Provider Name (Legal Business Name): BRIVANA HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 PLEASANT VALLEY RD STE 200
CHANTILLY VA
20151-1246
US

IV. Provider business mailing address

4211 PLEASANT VALLEY RD STE 200
CHANTILLY VA
20151-1246
US

V. Phone/Fax

Practice location:
  • Phone: 571-888-6889
  • Fax:
Mailing address:
  • Phone: 571-888-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SATYANARAYANA KUNTHSAM
Title or Position: CEO
Credential:
Phone: 571-888-6889