Provider Demographics
NPI:1083636179
Name:BELLA VISTA HOSPITAL INC
Entity Type:Organization
Organization Name:BELLA VISTA HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRATACOS NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:787-652-6044
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1750
Mailing Address - Country:US
Mailing Address - Phone:787-834-6000
Mailing Address - Fax:787-805-3705
Practice Address - Street 1:CARRETERA 349 KM 2.7
Practice Address - Street 2:CERRO LAS MESAS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-6000
Practice Address - Fax:787-805-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR50282N00000X
PRAPM 126332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400014Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PR1059480001Medicare NSC