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General NPI Number Information
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NPI Number | 1215304910
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Entity Type | Organization
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Legal Business Name | BUENA VIDA HOME CARE LLC
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 500 E SPRAGUE ST
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City | EDINBURG
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State | TX
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Zip | 78539-4658
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Country | US
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Telephone | 956-270-1145
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Fax | 877-723-0837
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Provider Business Mailing Address
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Address Line | 500 E SPRAGUE ST
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City | EDINBURG
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State | TX
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Zip | 78539-4658
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Country | US
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Telephone | 956-270-1145
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Fax | 877-723-0837
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MARICELLA GARCIA
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Credential |
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Telephone | 956-270-1145
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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 | 016874
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License Number State | TX
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