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General NPI Number Information
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NPI Number | 1831480441
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Entity Type | Organization
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Legal Business Name | VIVIANCE ADULT DAY HEALTH
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 522 PARK AVE W
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City | MANSFIELD
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State | OH
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Zip | 44906-3720
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Country | US
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Telephone | 419-610-0057
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Fax |
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Provider Business Mailing Address
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Address Line | 454 BROADVIEW AVE
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City | MANSFIELD
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State | OH
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Zip | 44903-1946
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Country | US
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Telephone | 419-610-0057
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. EDEISHA E BROOKS
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Credential |
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Telephone | 419-610-0057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | RR817269
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License Number State | OH
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