Healthcare Provider Details

I. General information

NPI: 1245546365
Provider Name (Legal Business Name): BELLA VIDA HOME HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 60TH ST
WEST NEW YORK NJ
07093-5412
US

IV. Provider business mailing address

317 60TH ST
WEST NEW YORK NJ
07093-5412
US

V. Phone/Fax

Practice location:
  • Phone: 201-869-4541
  • Fax: 201-869-3917
Mailing address:
  • Phone: 201-869-4541
  • Fax: 201-869-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. AIDA VIRGINIA ROQUE-DIAZ
Title or Position: PRESIDENT/CEO
Credential:
Phone: 201-869-4541