Healthcare Provider Details

I. General information

NPI: 1356974646
Provider Name (Legal Business Name): BUENA VIDA ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 PRESTON HWY
LOUISVILLE KY
40213-2146
US

IV. Provider business mailing address

8611 FENWICK CREEK PL APT D
LOUISVILLE KY
40220-5835
US

V. Phone/Fax

Practice location:
  • Phone: 502-298-1455
  • Fax:
Mailing address:
  • Phone: 502-298-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YARIMA ELENA HERNANDEZ PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 502-298-1455