Healthcare Provider Details

I. General information

NPI: 1891482683
Provider Name (Legal Business Name): LA VIDA BUENA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLLINS DR
LAS VEGAS NM
87701-4826
US

IV. Provider business mailing address

2301 COLLINS DR
LAS VEGAS NM
87701-4826
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-9362
  • Fax: 505-425-8518
Mailing address:
  • Phone: 505-425-9362
  • Fax: 505-425-8518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID GARETZ
Title or Position: CFO
Credential:
Phone: 323-987-5954