Provider Demographics
NPI:1558591917
Name:SU VIDA HOME HEALTH, LLC
Entity Type:Organization
Organization Name:SU VIDA HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:512-801-5403
Mailing Address - Street 1:7700 N. SH130 SVRD SB
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724
Mailing Address - Country:US
Mailing Address - Phone:512-801-5403
Mailing Address - Fax:512-276-1004
Practice Address - Street 1:7700 N. SH130 SVRD SB
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-7200
Practice Address - Country:US
Practice Address - Phone:512-801-5403
Practice Address - Fax:512-276-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health