Pura Vida Recovery Services, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

PURA VIDA RECOVERY SERVICES, LLC

Doing business as

Pura Vida Recovery Services

Practice address

5761 Mountain Hawk Dr Ste 201
Santa Rosa, CA 95409-4454

Phone

(707) 879-8432

Fax

(844) 426-0134

NPI assigned

Jan 11, 2023

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 identifiers 1

Other names 1

• Pura Vida Recovery Services Doing business as

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678233600000",
    "number": "1194439430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 STONY POINT RD STE J",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014120",
            "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": "5761 MOUNTAIN HAWK DR STE 201",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954094454",
            "telephone_number": "707-879-8432",
            "fax_number": "844-426-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURA VIDA RECOVERY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "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": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA DHCS",
            "identifier": "490041BP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pura Vida Recovery Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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)
• Parwinder Purewal

• Substance Abuse Rehabilitation Facility in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; 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.