Provider Demographics
NPI:1245811025
Name:VIVID RECOVERY, LLC
Entity type:Organization
Organization Name:VIVID RECOVERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:RASKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-387-7776
Mailing Address - Street 1:1634 BENEDICT CANYON DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-2003
Mailing Address - Country:US
Mailing Address - Phone:484-387-7776
Mailing Address - Fax:310-861-8830
Practice Address - Street 1:1634 BENEDICT CANYON DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-2003
Practice Address - Country:US
Practice Address - Phone:484-387-7776
Practice Address - Fax:310-861-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility