1396067716 NPI number — ALIVIANE, INC.

Table of content: (NPI 1679505069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396067716 NPI number — ALIVIANE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALIVIANE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
METHADONE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396067716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/17/2019
NPI Reactivation Date:
12/15/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 371710
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79937-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-775-4638
Provider Business Mailing Address Fax Number:
915-778-3342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 WYOMING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79903-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-779-3764
Provider Business Practice Location Address Fax Number:
915-775-0283
Provider Enumeration Date:
02/26/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAPIA
Authorized Official First Name:
IVONNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
915-782-4000

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  402I , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , with the licence number: 402A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 402A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 212223601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 402A . This is a "DSHS LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".