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General NPI Number Information
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NPI Number | 1134107683
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Entity Type | Organization
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Legal Business Name | BUENA VIDA HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3800 ENGLEWOOD LN
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City | ODESSA
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State | TX
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Zip | 79762-7073
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Country | US
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Telephone | 432-362-2583
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Fax | 432-362-8384
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Provider Business Mailing Address
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Address Line | 3800 ENGLEWOOD LN
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City | ODESSA
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State | TX
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Zip | 79762-7073
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Country | US
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Telephone | 432-362-2583
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Fax | 432-362-8384
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Authorized Official
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Title or Position | SECRETARY, BOARD OF DIRECTORS
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Name | MR. CHARLES H. LAM
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Credential |
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Telephone | 239-514-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 117174
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License Number State | TX
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