Provider Demographics
NPI:1164922878
Name:VISTA RIDGE TX LLC
Entity Type:Organization
Organization Name:VISTA RIDGE TX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-337-3922
Mailing Address - Street 1:5885 MEADOWS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8646
Mailing Address - Country:US
Mailing Address - Phone:971-245-1368
Mailing Address - Fax:
Practice Address - Street 1:400 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3871
Practice Address - Country:US
Practice Address - Phone:972-315-1532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility