Provider Demographics
NPI:1376203471
Name:VENI VIDI VICI TREATMENT SERVICES, LLC.
Entity Type:Organization
Organization Name:VENI VIDI VICI TREATMENT SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-819-3172
Mailing Address - Street 1:4B NORTH AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2304
Mailing Address - Country:US
Mailing Address - Phone:540-760-6285
Mailing Address - Fax:
Practice Address - Street 1:4B NORTH AVE STE 302
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2304
Practice Address - Country:US
Practice Address - Phone:540-760-6285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder