| Vivent Health Inc | |
|
1212 57th St Kenosha WI 53140-4069 | |
| (262) 657-6644 | |
| (262) 657-6949 |
| Full Name | Vivent Health Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1212 57th St, Kenosha, Wisconsin |
| Authorized Official Name and Position | Tim Dyer (EXEC VP) |
| Authorized Official Contact | 4142251611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivent Health Inc 820 N Plankinton Ave Milwaukee WI 53203-1802 Ph: (414) 225-1542 | Vivent Health Inc 1212 57th St Kenosha WI 53140-4069 Ph: (262) 657-6644 |
| NPI Number | 1841584232 |
|---|---|
| Provider Enumeration Date | 06/03/2011 |
| Last Update Date | 05/12/2022 |
| Certification Date | 05/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841584232 | NPI | - | NPPES |
| 42228200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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