MEDICARE: VVID LLC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1598519357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VVID LLC

Provider Business Mailing Address
First Line	:	PO BOX 786
Second Line	:
City	:	BETHEL ISLAND
State	:	CA
Zip	:	94511-0786
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 SAND CREEK RD # CA230
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2215
Country	:	US
Telephone Number	:	925-663-8158
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPHINE HARTS
Credential	:	NP
Telephone Number	:	707-567-1674

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	10/10/2024

Similar Medicare Providers

1194976795 — CAROLYN BREAUD LMFT
Practice Location Address:

191 SAND CREEK RD , SUITE 202-K
BRENTWOOD, CA
94513-2215

Practice Phone: 925-759-0235
Practice Fax:

1831415587 — DR. COLLEEN NOEL PENNINGTON PSY.D.
Practice Location Address:

191 SAND CREEK RD , SUITE 202 E
BRENTWOOD, CA
94513-2215

Practice Phone: 925-642-1987
Practice Fax:

1629476528 — SMITH MASSAGE THERAPY
Practice Location Address:

191 SAND CREEK RD , SUITE 202-B
BRENTWOOD, CA
94513-2215

Practice Phone: 925-812-0344
Practice Fax:

1033502760 — MRS. KRISTIN M PALMER MS
Practice Location Address:

191 SAND CREEK RD , SUITE 202F
BRENTWOOD, CA
94513-2215

Practice Phone: 925-301-3360
Practice Fax:

1053913251 — CHARLOTTE GLENN MOLALI LCSW
Practice Location Address:

191 SAND CREEK RD
BRENTWOOD, CA
94513-2215

Practice Phone: 925-663-8158
Practice Fax: 925-523-0916

1518738921 — KERRY BREMHORST LMFT
Practice Location Address:

191 SAND CREEK RD STE 202M
BRENTWOOD, CA
94513-2215

Practice Phone: 925-818-4981
Practice Fax:

Directions to “VVID LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.