Provider Demographics
NPI:1760193486
Name:THE GOOD VIBES LLC
Entity Type:Organization
Organization Name:THE GOOD VIBES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMBUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIANTURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-725-9374
Mailing Address - Street 1:5933 S WENATCHEE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6658
Mailing Address - Country:US
Mailing Address - Phone:720-412-3394
Mailing Address - Fax:720-222-5150
Practice Address - Street 1:5933 S WENATCHEE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-6658
Practice Address - Country:US
Practice Address - Phone:720-412-3394
Practice Address - Fax:720-222-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health