PURA VIDA RECOVERY SERVICES, LLC (NPI# 1346786696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346786696 |
| Entity Type | Organization |
| Organization Name | PURA VIDA RECOVERY SERVICES, LLC |
| Practice Address |
130 Stony Point Rd Santa Rosa CA 95401-4120 |
| Mailing Address |
130 Stony Point Rd Ste D Santa Rosa CA 95401-4120 |
| Practice Telephone | 7073385927 |
| Mailing Telephone | 7073385927 |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2018-03-08 |
| Authorized Official Name | BEN A PAHLAVAN (GENERAL MANAGER) |
| Authorized Official Telephone | 7073385927 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Street Address |
130 STONY POINT RD |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95401-4120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396743605 | Maria M. Petrick | Allergy & Immunology | 130 Stony Point Rd, Suite E, Santa Rosa, CA 95401-4120 | 2005-07-11 |
| 1730257932 | Allergy & Asthma Adult & Pediatric Medical Group of The Redwoods Inc | Allergy & Immunology | 130 Stony Point Rd, Suite E, Santa Rosa, CA 95401-4120 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972148575 | Megan Elizabeth Jones | In Home Supportive Care | 1239 Eardley Ave, Santa Rosa, CA 95401 | 2019-11-07 |
| 1801447230 | Patty Macisaac | Technician | 3221 Oak Farm Lane, Santa Rosa, CA 95401 | 2019-09-26 |
| 1386114981 | Victoria Maria Guillory | Dental Hygienist | 140 Stony Point Road, Suite A, Santa Rosa, CA 95401 | 2018-11-27 |
| 1811470727 | Chemarin Eve Boyd | Student in an Organized Health Care Education/Training Program | 1260 N Dutton Avenue, 225, Santa Rosa, CA 95401 | 2018-09-07 |
| 1073008181 | Cristavel Camacho | Behavioral Analyst | 1439 Range Ave, #101, Santa Rosa, CA 95401 | 2018-06-30 |
| 1619479102 | Victoria King | Behavior Technician | 1335 N. Dutton Ave., Santa Rosa, CA 95401 | 2018-03-01 |
| 1114436060 | Lacey Lynn Palmer | Counselor | 341 Irwin Lane, Santa Rosa, CA 95401 | 2017-09-22 |
| 1720530587 | Compassionate Homecare Solutions, LLC | In Home Supportive Care | 131 A Stony Circle, Suite 500, Santa Rosa, CA 95401 | 2016-10-27 |
| 1366998981 | William Glenn | Marriage & Family Therapist | 1496 Willowside Road, Santa Rosa, CA 95401 | 2016-09-01 |
| 1790144046 | Advocacy Home Nursing, Inc | Home Health | 1400 North Dutton Avenue, Suite 20, Santa Rosa, CA 95401 | 2016-02-15 |
| Find all providers in zip 95401 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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|---|---|---|---|---|
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| 1578807202 | Drug Abuse Alternatives Center | Clinic/Center | 983 Sonoma Avenue, Santa Rosa, CA 95404-4818 | 2012-11-19 |
| 1417168949 | Drug Abuse Alternatives Center | Clinic/Center | 2400 County Center Dr, Suite B, Santa Rosa, CA 95403-3004 | 2007-05-25 |
| 1043481344 | Drug Abuse Alternatives Center | Clinic/Center | 2400 County Center Dr, Suite B, Santa Rosa, CA 95403-3004 | 2008-03-14 |
| 1205030103 | R House, Inc. | Clinic/Center | 1207 Cleveland Ave, Santa Rosa, CA 95401-4729 | 2007-06-13 |
| 1306047295 | Drug Abuse Alternatives Center | Clinic/Center | 2400 County Center Drive, Suite B, Santa Rosa, CA 95403-3007 | 2007-05-30 |
| 1063623593 | Drug Abuse Alternatives Center | Clinic/Center | 2403 Professional Dr, Suite 101, Santa Rosa, CA 95403-3007 | 2007-05-25 |
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| Find all providers with the same taxonomy | ||||
| City | SANTA ROSA |
| Zip Code | 95401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.