Provider Demographics
NPI:1982247912
Name:LA VIDA DIVINA LLC
Entity Type:Organization
Organization Name:LA VIDA DIVINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-696-7417
Mailing Address - Street 1:302 E QUEEN ISABELLA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2407
Mailing Address - Country:US
Mailing Address - Phone:512-696-7417
Mailing Address - Fax:956-396-0555
Practice Address - Street 1:302 E QUEEN ISABELLA BLVD STE C
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2407
Practice Address - Country:US
Practice Address - Phone:512-696-7417
Practice Address - Fax:956-396-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty