Organization
PURA VIDA RECOVERY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEN A PAHLAVAN (CAO)
(707) 338-5927
Entity
Organization
Contact information
Practice address
130 STONY POINT RD, SANTA ROSA, CA 95401-4120
(707) 338-5927
Mailing address
130 STONY POINT RD STE J, SANTA ROSA, CA 95401-4120
(707) 338-5927
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
01/10/2017
Last updated
11/17/2020
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