Provider Demographics
NPI:1437574894
Name:VISTA CARE HOME INC.
Entity Type:Organization
Organization Name:VISTA CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIROSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-926-4303
Mailing Address - Street 1:10949 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1505
Mailing Address - Country:US
Mailing Address - Phone:818-361-4999
Mailing Address - Fax:818-361-1666
Practice Address - Street 1:10949 BURNET AVE
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1505
Practice Address - Country:US
Practice Address - Phone:818-361-4999
Practice Address - Fax:818-361-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002566314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002566Medicaid