Pura Vida Recovery Services, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

PURA VIDA RECOVERY SERVICES, LLC

Doing business as

Pura Vida Recovery Services

Practice address

2901 Cleveland Ave Ste 101&103
Santa Rosa, CA 95403-2785

Phone

(707) 879-8432

Fax

(844) 426-0134

NPI assigned

Oct 22, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ben A Pahlavan

Title

Cao

Phone

(707) 879-8432

Specialties & licenses 1

Addresses

Other names 1

• Pura Vida Recovery Services Doing business as

Tax ID family

Pura Vida Recovery Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pura Vida Recovery Services, LLC

  dba Pura Vida Recovery Services

  • Substance Abuse Rehabilitation Facility
  • Santa Rosa, CA
  • NPI 1932926649
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1184445140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 CLEVELAND AVE STE 103",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032788",
            "telephone_number": "707-879-8432",
            "fax_number": "844-426-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 CLEVELAND AVE STE 101&103",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032785",
            "telephone_number": "707-879-8432",
            "fax_number": "844-426-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURA VIDA RECOVERY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-22",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "PAHLAVAN",
        "authorized_official_first_name": "BEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "707-879-8432"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pura Vida Recovery Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pura Vida Recovery Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daisy Pulido
• Julisa Irene Pulido
• George James Pulis, M.A.
• Keith Lauren Pullin, P.T., D.P.T.
• Harendra Keshavlal Punatar, M.D.
• Pura Vida Recovery Services, LLC (Pura Vida Recovery Services)
• Pura Vida Recovery Services, LLC (Pura Vida Recovery Services)
• Pura Vida Recovery Services, LLC
• Pura Vida Recovery Services, LLC
• Pura Vida Recovery Services, LLC (Pura Vida Recovery Services)

• Substance Use Disorder Rehabilitation Clinic/Center in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.