Provider Demographics
NPI:1023005683
Name:NEW VISTA HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NEW VISTA HEALTH SERVICES, INC.
Other - Org Name:NEW VISTA POST ACUTE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:DEE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:310-477-5501
Mailing Address - Street 1:1516 SAWTELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3207
Mailing Address - Country:US
Mailing Address - Phone:310-477-5501
Mailing Address - Fax:310-473-8363
Practice Address - Street 1:1516 SAWTELLE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3207
Practice Address - Country:US
Practice Address - Phone:310-477-5501
Practice Address - Fax:310-473-8363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910000018314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05473JMedicaid
CALTC70109FMedicaid
CALTC70109FMedicaid
CAZZT05473JMedicaid