Healthcare Provider Details

I. General information

NPI: 1265014245
Provider Name (Legal Business Name): BUENA VIDA HOME HEALTH AGENCY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 W DEVON AVE
CHICAGO IL
60646-4108
US

IV. Provider business mailing address

4017 N MELVINA AVE APT 1
CHICAGO IL
60634-5433
US

V. Phone/Fax

Practice location:
  • Phone: 773-875-5879
  • Fax:
Mailing address:
  • Phone: 773-875-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIA AIDA RAMOS
Title or Position: PRESIDENT
Credential: OWNER
Phone: 773-875-5879