Provider Demographics
NPI:1356111942
Name:VIVAVITAL HEALTH SERVICES
Entity type:Organization
Organization Name:VIVAVITAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHYSSA
Authorized Official - Middle Name:RENAY
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:956-709-8714
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78595-1195
Mailing Address - Country:US
Mailing Address - Phone:956-709-8714
Mailing Address - Fax:956-291-3633
Practice Address - Street 1:211 E EXPRESSWAY 83 STE E
Practice Address - Street 2:
Practice Address - City:SULLIVAN CITY
Practice Address - State:TX
Practice Address - Zip Code:78595-2011
Practice Address - Country:US
Practice Address - Phone:956-709-8712
Practice Address - Fax:956-291-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty