Healthcare Provider Details

I. General information

NPI: 1992783484
Provider Name (Legal Business Name): BUENA VIDA HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5027 PECAN GRV
SAN ANTONIO TX
78222-3529
US

IV. Provider business mailing address

5027 PECAN GRV
SAN ANTONIO TX
78222-3529
US

V. Phone/Fax

Practice location:
  • Phone: 210-333-6815
  • Fax: 210-333-7400
Mailing address:
  • Phone: 210-333-6815
  • Fax: 210-333-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116927
License Number StateTX

VIII. Authorized Official

Name: MR. CHARLES H. LAM
Title or Position: SECRETARY, BOARD OF DIRECTORS
Credential:
Phone: 239-514-4484