Provider Demographics
NPI:1629184189
Name:VIVA HEALTH ADMINISTRATION, L.L.C.
Entity type:Organization
Organization Name:VIVA HEALTH ADMINISTRATION, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-558-7401
Mailing Address - Street 1:3704 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1526
Mailing Address - Country:US
Mailing Address - Phone:205-558-7401
Mailing Address - Fax:205-558-7538
Practice Address - Street 1:417 20TH ST N
Practice Address - Street 2:SUITE 1100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3203
Practice Address - Country:US
Practice Address - Phone:205-558-7587
Practice Address - Fax:205-558-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 1490251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL580500003Medicaid