Provider Demographics
NPI:1245266501
Name:BUENAVIDA HOME AND COMMUNITY SERVICES COMPANY
Entity type:Organization
Organization Name:BUENAVIDA HOME AND COMMUNITY SERVICES COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MS COUNSELING
Authorized Official - Phone:972-475-4047
Mailing Address - Street 1:9701 LANCASHIRE DR N
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8774
Mailing Address - Country:US
Mailing Address - Phone:972-475-4047
Mailing Address - Fax:972-475-4047
Practice Address - Street 1:9701 LANCASHIRE DR N
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8774
Practice Address - Country:US
Practice Address - Phone:972-475-4047
Practice Address - Fax:972-475-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health