Provider Demographics
NPI:1427375823
Name:VISTA VERANDA VILLAGE CORPORATION
Entity Type:Organization
Organization Name:VISTA VERANDA VILLAGE CORPORATION
Other - Org Name:VISTA VERANDA ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:AUSTRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-333-0509
Mailing Address - Street 1:3540 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262
Mailing Address - Country:US
Mailing Address - Phone:310-638-4113
Mailing Address - Fax:310-885-5432
Practice Address - Street 1:3540 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-638-4113
Practice Address - Fax:310-885-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608044310400000X
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility