Provider Demographics
NPI:1134107683
Name:BUENA VIDA HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:BUENA VIDA HEALTH SERVICES, INC.
Other - Org Name:BUENA VIDA NURSING & REHABILITATION CENTER OF ODESSA
Other - Org Type:Doing Business As
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 1:3800 ENGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-7073
Mailing Address - Country:US
Mailing Address - Phone:432-362-2583
Mailing Address - Fax:432-362-8384
Practice Address - Street 1:3800 ENGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-7073
Practice Address - Country:US
Practice Address - Phone:432-362-2583
Practice Address - Fax:432-362-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117174314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-5145Medicare ID - Type Unspecified