An opening and closing body drive device for a vehicle includes a belt frame, plural driven pulleys, a belt wounded around the plural driven pulleys and fixed with a connector with respect to an opening and closing body, a drive unit provided with an output shaft including a rotary axis which extends in a different direction from a rotary axis of each of the plural driven pulleys, and a drive pulley connected to the output shaft of the drive unit. The drive pulley includes a rotary axis extending in the different direction from the rotary axis of each of the plural driven pulleys while extending in the same direction as the rotary axis of the output shaft. The drive pulley is wound with the belt which is twisted between the driven pulleys arranged at opposing sides of the drive pulley in a circumferential direction of the belt.