Provider Demographics
NPI:1487843298
Name:BIENVIVIR SENIOR HEALTH SERVICES
Entity type:Organization
Organization Name:BIENVIVIR SENIOR HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-562-3444
Mailing Address - Street 1:2300 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-2240
Mailing Address - Country:US
Mailing Address - Phone:915-562-3444
Mailing Address - Fax:
Practice Address - Street 1:2300 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-2240
Practice Address - Country:US
Practice Address - Phone:915-562-3444
Practice Address - Fax:915-834-3770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIENVIVIR SENIOR HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX239753336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000999817Medicaid
4536061OtherOTHER ID NUMBER