Provider Demographics
NPI:1992783484
Name:BUENA VIDA HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:BUENA VIDA HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-514-4484
Mailing Address - Street 1:5027 PECAN GRV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3529
Mailing Address - Country:US
Mailing Address - Phone:210-333-6815
Mailing Address - Fax:210-333-7400
Practice Address - Street 1:5027 PECAN GRV
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3529
Practice Address - Country:US
Practice Address - Phone:210-333-6815
Practice Address - Fax:210-333-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116927314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-5390Medicare ID - Type Unspecified