Provider Demographics
NPI:1689166464
Name:BUENA VIDA FAMILY CENTER
Entity Type:Organization
Organization Name:BUENA VIDA FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAZARES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:817-376-9841
Mailing Address - Street 1:1714 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3939
Mailing Address - Country:US
Mailing Address - Phone:817-376-9841
Mailing Address - Fax:972-236-0092
Practice Address - Street 1:1714 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-3939
Practice Address - Country:US
Practice Address - Phone:817-376-9841
Practice Address - Fax:972-236-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1326466558Medicaid