Provider Demographics
NPI:1265891162
Name:INNERCHANGE VIVE
Entity type:Organization
Organization Name:INNERCHANGE VIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-829-4060
Mailing Address - Street 1:5500 MING AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4631
Mailing Address - Country:US
Mailing Address - Phone:661-622-4132
Mailing Address - Fax:
Practice Address - Street 1:1150 MAXWELL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4185
Practice Address - Country:US
Practice Address - Phone:303-449-2516
Practice Address - Fax:303-449-4341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLACIUM HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-19
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty