Healthcare Provider Details

I. General information

NPI: 1215114517
Provider Name (Legal Business Name): BUENA VIDA ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 BEVERLY BLVD
LOS ANGELES CA
90026-5710
US

IV. Provider business mailing address

1617 BEVERLY BLVD
LOS ANGELES CA
90026-5710
US

V. Phone/Fax

Practice location:
  • Phone: 213-250-9191
  • Fax: 213-250-9595
Mailing address:
  • Phone: 213-250-9191
  • Fax: 213-250-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. BEHKAM NIKAEIN
Title or Position: CEO
Credential:
Phone: 213-250-9191