Provider Demographics
NPI:1568928349
Name:VIDA FOR AUTISM, LLC
Entity type:Organization
Organization Name:VIDA FOR AUTISM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:323-388-6178
Mailing Address - Street 1:5250 LANKERSHIM BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3187
Mailing Address - Country:US
Mailing Address - Phone:818-350-3839
Mailing Address - Fax:
Practice Address - Street 1:5250 LANKERSHIM BLVD STE 500
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3187
Practice Address - Country:US
Practice Address - Phone:818-350-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIDA FOR AUTISM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-16
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities