Healthcare Provider Details

I. General information

NPI: 1518681659
Provider Name (Legal Business Name): BUENA VISTA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ELMWOOD ST
VADNAIS HEIGHTS MN
55127
US

IV. Provider business mailing address

4000 ELMWOOD ST
VADNAIS HEIGHTS MN
55127
US

V. Phone/Fax

Practice location:
  • Phone: 651-235-9263
  • Fax: 651-426-8117
Mailing address:
  • Phone: 651-235-9263
  • Fax: 651-426-8117

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 OFFELIA GOMEZ
Title or Position: CEO
Credential: RN
Phone: 651-235-9263