Provider Demographics
NPI:1265014245
Name:BUENA VIDA HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:BUENA VIDA HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:AIDA
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:773-875-5879
Mailing Address - Street 1:4017 N MELVINA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5433
Mailing Address - Country:US
Mailing Address - Phone:773-875-5879
Mailing Address - Fax:
Practice Address - Street 1:5318 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4108
Practice Address - Country:US
Practice Address - Phone:773-875-5879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health