Provider Demographics
NPI:1215696430
Name:AVIVA MENTAL HEALTH SERVICES INC
Entity type:Organization
Organization Name:AVIVA MENTAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSMARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-522-4506
Mailing Address - Street 1:320 MACDADE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1926
Mailing Address - Country:US
Mailing Address - Phone:610-522-4506
Mailing Address - Fax:610-522-4508
Practice Address - Street 1:320 MACDADE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-1926
Practice Address - Country:US
Practice Address - Phone:610-522-4506
Practice Address - Fax:610-522-4508
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVIVA MENTAL HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034994870001Medicaid