Healthcare Provider Details

I. General information

NPI: 1811008998
Provider Name (Legal Business Name): BUENA VISTA PALLIATIVE CARE & HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 PALMA DR STE 108
VENTURA CA
93003-5796
US

IV. Provider business mailing address

1732 PALMA DR STE 108
VENTURA CA
93003-5796
US

V. Phone/Fax

Practice location:
  • Phone: 805-676-1453
  • Fax: 805-676-1457
Mailing address:
  • Phone: 805-676-1453
  • Fax: 805-676-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number050000273
License Number StateCA

VIII. Authorized Official

Name: ANDREA DOCTOR
Title or Position: LCSW/ADMINISTRATOR
Credential:
Phone: 805-676-1453