Organization
VIVENT HEALTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM DYER (EXEC VP)
(414) 225-1611
Entity
Organization
Contact information
Practice address
1212 57TH ST, KENOSHA, WI 53140-4069
(262) 657-6644
(262) 657-6949
Mailing address
820 N PLANKINTON AVE, MILWAUKEE, WI 53203-1802
(414) 225-1542
(414) 225-1575
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42228200
—
WI
Enumeration date
06/03/2011
Last updated
05/12/2022
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