| Vida Recovery Llc | |
|
10127 Morocco St Ste 196 San Antonio TX 78216-3943 | |
| (830) 216-6563 | |
| (330) 595-4025 |
| Full Name | Vida Recovery Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10127 Morocco St Ste 196, San Antonio, Texas |
| Authorized Official Name and Position | Shiloh Mcclelland (ADMINISTRATOR) |
| Authorized Official Contact | 3302272291 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vida Recovery Llc 812 Poplar St Jourdanton TX 78026-2940 Ph: (830) 399-5010 | Vida Recovery Llc 10127 Morocco St Ste 196 San Antonio TX 78216-3943 Ph: (830) 216-6563 |
| NPI Number | 1235911611 |
|---|---|
| Provider Enumeration Date | 10/19/2023 |
| Last Update Date | 12/02/2024 |
| Certification Date | 12/02/2024 |
| Medicare PECOS PAC ID | 7618314295 |
|---|---|
| Medicare Enrollment ID | O20240318003653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235911611 | NPI | - | NPPES |
| Provider Name | Charles E Junkin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811070782 PECOS PAC ID: 9436596012 Enrollment ID: I20240318003694 |
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