Provider Demographics
NPI:1073999470
Name:VISTA MONTANA SENIOR LIVING INC.
Entity Type:Organization
Organization Name:VISTA MONTANA SENIOR LIVING INC.
Other - Org Name:VISTA MONTANA SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-430-2994
Mailing Address - Street 1:155 N GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4624
Mailing Address - Country:US
Mailing Address - Phone:951-658-2274
Mailing Address - Fax:951-765-2025
Practice Address - Street 1:155 N GIRARD ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4624
Practice Address - Country:US
Practice Address - Phone:951-658-2274
Practice Address - Fax:951-765-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336426330310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility