Provider Demographics
NPI:1679894422
Name:ALIVIANE, INC.
Entity type:Organization
Organization Name:ALIVIANE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-782-4000
Mailing Address - Street 1:PO BOX 371710
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79937-1710
Mailing Address - Country:US
Mailing Address - Phone:915-775-4638
Mailing Address - Fax:915-778-3342
Practice Address - Street 1:10690 SOCORRO RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79927-2332
Practice Address - Country:US
Practice Address - Phone:915-858-6208
Practice Address - Fax:915-858-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX402B261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX402BOtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX216276001Medicaid