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General NPI Number Information
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NPI Number | 1841584232
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Entity Type | Organization
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Legal Business Name | VIVENT HEALTH INC
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 1212 57TH ST
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City | KENOSHA
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State | WI
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Zip | 53140-4069
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Country | US
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Telephone | 262-657-6644
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Fax | 262-657-6949
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Provider Business Mailing Address
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Address Line | 820 N PLANKINTON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53203-1802
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Country | US
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Telephone | 414-225-1542
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Fax | 414-225-1575
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Authorized Official
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Title or Position | EXEC VP
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Name | MR. TIM DYER
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Credential |
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Telephone | 414-225-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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