Provider Demographics
NPI:1316386824
Name:BUENA VISTA HEALTH CARE CORP.
Entity Type:Organization
Organization Name:BUENA VISTA HEALTH CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AGUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EXPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-838-5937
Mailing Address - Street 1:4230 NW 196TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1813
Mailing Address - Country:US
Mailing Address - Phone:786-838-5937
Mailing Address - Fax:
Practice Address - Street 1:4230 NW 196TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1813
Practice Address - Country:US
Practice Address - Phone:786-838-5937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12368310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility