Provider Demographics
NPI:1568565471
Name:BELLA VISTA HOSPITAL INC
Entity Type:Organization
Organization Name:BELLA VISTA HOSPITAL INC
Other - Org Name:BELLA VISTA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:787-652-6045
Mailing Address - Street 1:5 BELLA VISTA GDNS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-8312
Mailing Address - Country:US
Mailing Address - Phone:787-652-6045
Mailing Address - Fax:787-831-6315
Practice Address - Street 1:CARR 349 KM2.7 CERRO LAS MESAS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1750
Practice Address - Country:US
Practice Address - Phone:787-652-6045
Practice Address - Fax:787-831-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAPM126332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1059480001Medicare NSC
PR1059480001Medicare PIN