Provider Demographics
NPI:1407073075
Name:BLUE VISTA HOME HEALTH LLC
Entity Type:Organization
Organization Name:BLUE VISTA HOME HEALTH LLC
Other - Org Name:ASSIST HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-665-9919
Mailing Address - Street 1:12 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1010
Mailing Address - Country:US
Mailing Address - Phone:954-698-2900
Mailing Address - Fax:954-908-8806
Practice Address - Street 1:12 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1010
Practice Address - Country:US
Practice Address - Phone:954-698-2900
Practice Address - Fax:954-908-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992583251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health