Organization
PURA VIDA RECOVERY SERVICES, LLC
Active
Other names
Pura Vida Recovery Services
Organization subpart
No
Provider details
NPI number
Authorized official
BEN A PAHLAVAN (CAO)
(707) 879-8432
Entity
Organization
Contact information
Practice address
5761 MOUNTAIN HAWK DR STE 201, SANTA ROSA, CA 95409-4454
(707) 879-8432
(844) 426-0134
Mailing address
130 STONY POINT RD STE J, SANTA ROSA, CA 95401-4120
(707) 879-8432
(844) 426-0134
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490041BP
CA DHCS
CA
Enumeration date
01/11/2023
Last updated
03/08/2023
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