Provider Demographics
NPI:1770160681
Name:VIDA HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:VIDA HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, DON
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-542-5164
Mailing Address - Street 1:6001 NW 153RD ST
Mailing Address - Street 2:STE 140
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2475
Mailing Address - Country:US
Mailing Address - Phone:786-541-6164
Mailing Address - Fax:
Practice Address - Street 1:6001 NW 153RD ST STE 140
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2475
Practice Address - Country:US
Practice Address - Phone:786-541-6164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299995350OtherAHCA