Provider Demographics
NPI:1487640066
Name:CITY HEIGHTS HEALTH ASSOCIATES LLC
Entity Type:Organization
Organization Name:CITY HEIGHTS HEALTH ASSOCIATES LLC
Other - Org Name:ARROYO VISTA NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:3022 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4302
Mailing Address - Country:US
Mailing Address - Phone:619-283-5855
Mailing Address - Fax:619-284-6327
Practice Address - Street 1:3022 45TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-4302
Practice Address - Country:US
Practice Address - Phone:619-283-5855
Practice Address - Fax:619-284-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000016314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487640066Medicaid
CA1487640066Medicaid