Provider Demographics
NPI:1083932354
Name:TRANSITION HEALTH SERVICES-VIDA ENCANTADA, LLC
Entity Type:Organization
Organization Name:TRANSITION HEALTH SERVICES-VIDA ENCANTADA, LLC
Other - Org Name:VIDA ENCANTADA NURSING AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-464-7018
Mailing Address - Street 1:415 HIGHWAY 377 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-5140
Mailing Address - Country:US
Mailing Address - Phone:940-464-7010
Mailing Address - Fax:940-464-7011
Practice Address - Street 1:2301 COLLINS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4826
Practice Address - Country:US
Practice Address - Phone:505-425-9362
Practice Address - Fax:505-425-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility