Provider Demographics
NPI:1245546365
Name:BELLA VIDA HOME HEALTH SERVICES, INC
Entity type:Organization
Organization Name:BELLA VIDA HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:ROQUE-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-869-4541
Mailing Address - Street 1:317 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5412
Mailing Address - Country:US
Mailing Address - Phone:201-869-4541
Mailing Address - Fax:201-869-3917
Practice Address - Street 1:317 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5412
Practice Address - Country:US
Practice Address - Phone:201-869-4541
Practice Address - Fax:201-869-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343800000XTransportation ServicesSecured Medical Transport (VAN)