Provider Demographics
NPI:1619016177
Name:BIENVIVIR SENIOR HEALTH SERVICES
Entity Type:Organization
Organization Name:BIENVIVIR SENIOR HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-562-3444
Mailing Address - Street 1:2300 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-2240
Mailing Address - Country:US
Mailing Address - Phone:915-562-3444
Mailing Address - Fax:915-834-3740
Practice Address - Street 1:2300 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-2240
Practice Address - Country:US
Practice Address - Phone:915-562-3444
Practice Address - Fax:915-834-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000999817251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000999817Medicaid