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General NPI Number Information
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NPI Number | 1932981214
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Entity Type | Organization
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Legal Business Name | VIDA MENTAL HEALTH SOLUTIONS
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 01/14/2024
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Provider Practice Location Address
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Address Line | 333 E IL ROUTE 83 STE 205
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City | MUNDELEIN
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State | IL
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Zip | 60060-4279
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Country | US
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Telephone | 847-979-9095
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 ESTATE LN
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City | GLENVIEW
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State | IL
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Zip | 60025-1520
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Country | US
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Telephone | 847-979-9095
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARMELA SANCHEZ
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Credential | PA
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Telephone | 847-979-9095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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