Provider Demographics
NPI:1033112842
Name:VISTA CONTINUING CARE CENTER INC
Entity Type:Organization
Organization Name:VISTA CONTINUING CARE CENTER INC
Other - Org Name:VISTA CONTINUING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-569-9023
Mailing Address - Street 1:4300 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2118
Mailing Address - Country:US
Mailing Address - Phone:713-946-6787
Mailing Address - Fax:713-946-1337
Practice Address - Street 1:4300 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2118
Practice Address - Country:US
Practice Address - Phone:713-946-6787
Practice Address - Fax:713-946-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111815314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000512001Medicaid
TX021984201Medicaid
TX675625Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER