Provider Demographics
NPI:1780069179
Name:AD-VIE
Entity type:Organization
Organization Name:AD-VIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GILET
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-339-1084
Mailing Address - Street 1:5939 W GREEN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2336
Mailing Address - Country:US
Mailing Address - Phone:619-339-1084
Mailing Address - Fax:
Practice Address - Street 1:5939 W GREEN BROOK DR
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2336
Practice Address - Country:US
Practice Address - Phone:619-339-1084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA735742302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization