Vida Health Wellness, PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

VIDA HEALTH WELLNESS, PLLC

Practice address

5747 W Fullerton Ave
Chicago, IL 60639-2353

Phone

(773) 413-7264

NPI assigned

Nov 3, 2023

Last updated

Jun 28, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Virginia Bahena, APRNNPI 1992411987

Title

Owner

Phone

(773) 413-7264

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Virginia Bahena, FNP-BC, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1992411987
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1698969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1720851413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5747 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606392353",
            "telephone_number": "773-413-7264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5747 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606392353",
            "telephone_number": "773-413-7264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDA HEALTH WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-03",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "BAHENA",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-413-7264",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victory Medical of Illinois PC
• Victory Medical Supply Inc
• Victory Pharmacy of Decatur Inc (Victory Pharmacy)
• Victory Place
• Victory RX, Inc (Local Health Pharmacy)
• Vida Medical Centers PLLC
• Vida Pediatrics, LTD.
• Vida Therapy
• Gabriel Ernest Vida, DDS
• Vidal Therapy PLLC

• Psychiatric/Mental Health Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.