1013617919 NPI number — VIRTUE RECOVERY LAS VEGAS, LLC

Table of content: SABA ASAD ANSARI M.D. (NPI 1780994673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013617919 NPI number — VIRTUE RECOVERY LAS VEGAS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRTUE RECOVERY LAS VEGAS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013617919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5850 CANOGA AVE STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91367-6505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-928-0038
Provider Business Mailing Address Fax Number:
818-806-0245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9230 CORBETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89149-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-928-0038
Provider Business Practice Location Address Fax Number:
818-806-0245
Provider Enumeration Date:
03/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MEZA
Authorized Official First Name:
MARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
818-928-0038

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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