Provider Demographics
NPI:1295212777
Name:VIVANTE HEALTH, INC.
Entity Type:Organization
Organization Name:VIVANTE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ACHINT
Authorized Official - Middle Name:
Authorized Official - Last Name:PRABHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-418-9365
Mailing Address - Street 1:2045 W GRAND AVE
Mailing Address - Street 2:SUITE B, PMB 37767
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1577
Mailing Address - Country:US
Mailing Address - Phone:479-970-5178
Mailing Address - Fax:
Practice Address - Street 1:2045 W GRAND AVE
Practice Address - Street 2:STE B, PMB 37767
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-6061
Practice Address - Country:US
Practice Address - Phone:615-542-2950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty