Provider Demographics
NPI:1255656781
Name:VISTA COVE CARE CENTER AT SANTA PAULA, INC.
Entity Type:Organization
Organization Name:VISTA COVE CARE CENTER AT SANTA PAULA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:BONAPARTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-205-4060
Mailing Address - Street 1:5 SAN JOAQUIN PLZ
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5923
Mailing Address - Country:US
Mailing Address - Phone:949-205-4060
Mailing Address - Fax:949-205-4061
Practice Address - Street 1:250 MARCH ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2512
Practice Address - Country:US
Practice Address - Phone:805-525-7134
Practice Address - Fax:805-933-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-27
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055957Medicare Oscar/Certification
CAZ055957Medicare PIN