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General NPI Number Information
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NPI Number | 1407073075
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Entity Type | Organization
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Legal Business Name | BLUE VISTA HOME HEALTH LLC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 12 SE 8TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1010
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Country | US
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Telephone | 954-698-2900
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Fax | 954-908-8806
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Provider Business Mailing Address
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Address Line | 12 SE 8TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1010
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Country | US
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Telephone | 954-698-2900
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Fax | 954-908-8806
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Authorized Official
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Title or Position | ADMIN
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Name | ERIKA MARIA AVILA
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Credential |
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Telephone | 305-665-9919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299992583
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License Number State | FL
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