Healthcare Provider Details

I. General information

NPI: 1316386824
Provider Name (Legal Business Name): BUENA VISTA HEALTH CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 NW 196TH ST
MIAMI GARDENS FL
33055-1813
US

IV. Provider business mailing address

4230 NW 196TH ST
MIAMI GARDENS FL
33055-1813
US

V. Phone/Fax

Practice location:
  • Phone: 786-838-5937
  • Fax:
Mailing address:
  • Phone: 786-838-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL12368
License Number StateFL

VIII. Authorized Official

Name: MR. AGUSTIN M EXPOSITO
Title or Position: OWNER
Credential:
Phone: 786-838-5937