Healthcare Provider Details

I. General information

NPI: 1508861675
Provider Name (Legal Business Name): BUENA VIDA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CEDAR ST
BROOKLYN NY
11221-3253
US

IV. Provider business mailing address

48 CEDAR ST
BROOKLYN NY
11221-3253
US

V. Phone/Fax

Practice location:
  • Phone: 718-455-6200
  • Fax: 718-452-7681
Mailing address:
  • Phone: 718-455-6200
  • Fax: 718-452-7681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001383N
License Number StateNY

VIII. Authorized Official

Name: SONIA RIVERA
Title or Position: DIRECTOR
Credential:
Phone: 718-484-0863