Healthcare Provider Details

I. General information

NPI: 1912689183
Provider Name (Legal Business Name): VIDA MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 01/07/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E IL ROUTE 83 STE 205
MUNDELEIN IL
60060-4279
US

IV. Provider business mailing address

1420 ESTATE LN
GLENVIEW IL
60025-1520
US

V. Phone/Fax

Practice location:
  • Phone: 847-979-9095
  • Fax: 847-233-1349
Mailing address:
  • Phone: 847-879-9095
  • Fax: 847-233-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARMELA SNCHEZ
Title or Position: OWNER
Credential: PA
Phone: 847-979-9095