Provider Demographics
NPI:1215114517
Name:BUENA VIDA ADHC, LLC
Entity type:Organization
Organization Name:BUENA VIDA ADHC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEHKAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKAEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-250-9191
Mailing Address - Street 1:1617 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5710
Mailing Address - Country:US
Mailing Address - Phone:213-250-9191
Mailing Address - Fax:213-250-9595
Practice Address - Street 1:1617 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5710
Practice Address - Country:US
Practice Address - Phone:213-250-9191
Practice Address - Fax:213-250-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care