Provider Demographics
NPI:1609489038
Name:VIANA HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:VIANA HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRBLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORETIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-822-2004
Mailing Address - Street 1:8205 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8205 MOCKINGBIRD DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3713
Practice Address - Country:US
Practice Address - Phone:617-842-6871
Practice Address - Fax:855-677-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities