Provider Demographics
NPI:1023200151
Name:SIERRA VISTA RESIDENTIAL CARE HOME,INC
Entity Type:Organization
Organization Name:SIERRA VISTA RESIDENTIAL CARE HOME,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-747-0399
Mailing Address - Street 1:782 N SHASTA AVE
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93223-1148
Mailing Address - Country:US
Mailing Address - Phone:559-747-0399
Mailing Address - Fax:559-747-0604
Practice Address - Street 1:782 N SHASTA AVE
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:CA
Practice Address - Zip Code:93223-1148
Practice Address - Country:US
Practice Address - Phone:559-747-0399
Practice Address - Fax:559-747-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55G188Medicaid
CA55G365Medicaid