Provider Demographics
NPI:1811008998
Name:BUENA VISTA PALLIATIVE CARE & HOME HEALTH, INC.
Entity Type:Organization
Organization Name:BUENA VISTA PALLIATIVE CARE & HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-676-1453
Mailing Address - Street 1:1732 PALMA DR STE 108
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5796
Mailing Address - Country:US
Mailing Address - Phone:805-676-1453
Mailing Address - Fax:805-676-1457
Practice Address - Street 1:1732 PALMA DR STE 108
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5796
Practice Address - Country:US
Practice Address - Phone:805-676-1453
Practice Address - Fax:805-676-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000273251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57165FMedicaid
CA557165Medicare ID - Type Unspecified