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General NPI Number Information
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NPI Number | 1104407386
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Entity Type | Organization
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Legal Business Name | VIDA FELIZ CARE AGENCY LLC
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 2401 MEADOWLARK DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-3457
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Country | US
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Telephone | 520-678-0706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1356
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City | SIERRA VISTA
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State | AZ
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Zip | 85636-1356
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | THERESA LANIKA MALONE
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Credential | RN
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Telephone | 520-678-1734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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