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General NPI Number Information
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NPI Number | 1902341118
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Entity Type | Organization
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Legal Business Name | VIDA FAMILY SERVICES
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Dates
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Enumeration Date | 12/23/2016
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Last Update Date | 12/23/2016
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Provider Practice Location Address
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Address Line | 4419 VAN NUYS BLVD 307
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2910
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Country | US
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Telephone | 818-986-1161
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Fax |
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Provider Business Mailing Address
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Address Line | 4419 VAN NUYS BLVD 307
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2910
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Country | US
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Telephone | 818-986-1161
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Fax |
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Authorized Official
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Title or Position | BILLING
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Name | NARA UPTON
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Credential |
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Telephone | 626-872-7344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 190915AP
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License Number State | CA
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