Provider Demographics
NPI:1215304910
Name:BUENA VIDA HOME CARE LLC
Entity type:Organization
Organization Name:BUENA VIDA HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARICELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-270-1145
Mailing Address - Street 1:500 E SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4658
Mailing Address - Country:US
Mailing Address - Phone:956-270-1145
Mailing Address - Fax:877-723-0837
Practice Address - Street 1:500 E SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4658
Practice Address - Country:US
Practice Address - Phone:956-270-1145
Practice Address - Fax:877-723-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016874253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care