MEDICARE: VIDA HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1932596954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA HEALTH, INC.

Provider Business Mailing Address
First Line	:	26 OFARRELL ST
Second Line	:	SUITE 310
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-5809
Country	:	US
Telephone Number	:	408-203-7959
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 OFARRELL ST
Second Line	:	SUITE 310
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-5809
Country	:	US
Telephone Number	:	408-203-7959
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHANIE TILENIUS
Credential	:
Telephone Number	:	408-203-7959

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	04/16/2015

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