Organization
VIVIANCE ADULT DAY HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EDEISHA E BROOKS (OWNER)
(419) 610-0057
Entity
Organization
Contact information
Practice address
522 PARK AVE W, MANSFIELD, OH 44906-3720
(419) 610-0057
Mailing address
454 BROADVIEW AVE, MANSFIELD, OH 44903-1946
(419) 610-0057
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
RR817269
OH
Other
Enumeration date
04/29/2011
Last updated
04/29/2011
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