VIDA HEALTH WELLNESS, PLLC
NPI 1720851413
Nurse Practitioner - Psychiatric/Mental Health in Chicago, IL

Active since November 03, 2023CLIA 14D2305917 · Waiver
5747 W FULLERTON AVE, CHICAGO, IL 60639(773) 413-7264 Get Directions Write a Review

NPPES record last updated: June 28, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 28, 2024, May 8, 2024, Nov 3, 2023 (3 updates tracked since 2023).

About Vida Health Wellness, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VIDA HEALTH WELLNESS, PLLC (NPI 1720851413) is a healthcare organization registered as a psychiatric/mental health in Chicago, Illinois and active in the NPI registry since November 2023. The organization holds a CLIA Waiver certificate valid through June 6, 2028 and lists Virginia Bahena, Owner, as its authorized official.

NPPES Registry Identity

NPI1720851413
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameVIDA HEALTH WELLNESS, PLLC
Location Address5747 W FULLERTON AVEChicago, IL 60639-2353
Mailing Address5747 W Fullerton AveChicago, IL 60639-2353 · (773) 413-7264
Organization SubpartNo
Authorized OfficialVirginia BahenaOwner · (773) 413-7264
Enumeration DateNovember 3, 2023
Last NPPES UpdateJune 28, 20243 updates tracked since enumeration
NPPES CertifiedJune 28, 2024
NPI 1720851413 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
5747 W FULLERTON AVE, Chicago, IL 60639

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2305917

Vida Health Wellness, PLLC · Chicago, IL
Active · expires Jun 6, 2028
CLIA Number14D2305917
Laboratory TypePractitioner Other
Certificate Effective DateJune 7, 2026
Certificate Expiration DateJune 6, 2028
Laboratory DirectorVirginia Bahena
Laboratory Phone(773) 413-7264
Laboratory LocationVida Health Wellness, PLLC5747 W Fullterton Ave, Chicago, IL 60639
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Psychiatric/Mental Health)
5747 W FULLERTON AVE
CHICAGO, IL 60639

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Vida Health Wellness, PLLC's NPI number?

The NPI number for Vida Health Wellness, PLLC is 1720851413. It was assigned to this organization in the NPPES registry on November 3, 2023.

Where is Vida Health Wellness, PLLC located?

Vida Health Wellness, PLLC is located at 5747 W Fullerton Ave, Chicago, IL 60639. The listed phone number is (773) 413-7264.

What is Vida Health Wellness, PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Does Vida Health Wellness, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2305917) is associated with this NPI, valid through June 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Vida Health Wellness, PLLC was last updated on June 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.