Healthcare Provider Details

I. General information

NPI: 1265769335
Provider Name (Legal Business Name): LA VIDA HERMOSA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 CALLE VERA CRUZ
SANTA FE NM
87505
US

IV. Provider business mailing address

2929 CALLE VERA CRUZ
SANTA FE NM
87507-4894
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-8031
  • Fax: 505-424-0681
Mailing address:
  • Phone: 505-474-8031
  • Fax: 505-424-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSE BABCOCK
Title or Position: PRESIDENT
Credential:
Phone: 505-474-8031