Provider Demographics
NPI:1912616954
Name:AVIVA NON-MEDICAL IN HOME CARE LLC
Entity Type:Organization
Organization Name:AVIVA NON-MEDICAL IN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DETTRANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-787-9002
Mailing Address - Street 1:2742 DUNSTAN LN
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-6156
Mailing Address - Country:US
Mailing Address - Phone:334-787-9002
Mailing Address - Fax:
Practice Address - Street 1:2742 DUNSTAN LN
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-6156
Practice Address - Country:US
Practice Address - Phone:334-787-9002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care