Provider Demographics
NPI:1508861675
Name:BUENA VIDA CORP
Entity Type:Organization
Organization Name:BUENA VIDA CORP
Other - Org Name:BUENA VIDA CONTINUING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-484-0863
Mailing Address - Street 1:48 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3253
Mailing Address - Country:US
Mailing Address - Phone:718-455-6200
Mailing Address - Fax:718-452-7681
Practice Address - Street 1:48 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3253
Practice Address - Country:US
Practice Address - Phone:718-455-6200
Practice Address - Fax:718-452-7681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001383N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02144049Medicaid
NY33-5826Medicare ID - Type Unspecified