Provider Demographics
NPI:1396067716
Name:ALIVIANE, INC.
Entity type:Organization
Organization Name:ALIVIANE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-782-4000
Mailing Address - Street 1:PO BOX 371710
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79937-1710
Mailing Address - Country:US
Mailing Address - Phone:915-775-4638
Mailing Address - Fax:915-778-3342
Practice Address - Street 1:1900 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3409
Practice Address - Country:US
Practice Address - Phone:915-779-3764
Practice Address - Fax:915-775-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2020-12-15
Deactivation Date:2019-05-17
Deactivation Code:
Reactivation Date:2020-12-15
Provider Licenses
StateLicense IDTaxonomies
TX402I251S00000X
TX402A261QM2800X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212223601Medicaid
TX402AOtherDSHS LICENSE NUMBER