Provider Demographics
NPI:1073158770
Name:BELLA VISTA HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:BELLA VISTA HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-357-7984
Mailing Address - Street 1:8700 RESEDA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6127
Mailing Address - Country:US
Mailing Address - Phone:818-812-6545
Mailing Address - Fax:
Practice Address - Street 1:8700 RESEDA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6127
Practice Address - Country:US
Practice Address - Phone:818-812-6545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based