Provider Demographics
NPI:1326385899
Name:AVIVA CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:AVIVA CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ARENDT
Authorized Official - Suffix:
Authorized Official - Credentials:MAFM, MBA, CHC, CFE
Authorized Official - Phone:520-327-1529
Mailing Address - Street 1:153 S PLUMER AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-6300
Mailing Address - Country:US
Mailing Address - Phone:520-327-6779
Mailing Address - Fax:520-327-6052
Practice Address - Street 1:153 S PLUMER AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-6300
Practice Address - Country:US
Practice Address - Phone:520-327-6779
Practice Address - Fax:520-327-6052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTER SEALS BLAKE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ042622Medicaid