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Contact Information

PROJECT VIDA, INC.
2659 S KEDVALE AVE
CHICAGO, IL60623-4322
 Phone: 773-277-2291
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Addiction (Substance Use Disorder)

101YA0400X
 

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
 

Counselor

101Y00000X
 

Mental Health

101YM0800X
 

Social Worker

104100000X
Indicates primary specialty

NPI Profile & details for PROJECT VIDA, INC.

NPI Number 1285167577
LBN Legal business name PROJECT VIDA, INC.
Authorized official JEROME MONTGOMERY - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 04/04/2017
Last updated 04/04/2017 - About 9 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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