Provider Demographics
NPI:1619193729
Name:LINDA VISTA MANOR, INC.
Entity Type:Organization
Organization Name:LINDA VISTA MANOR, INC.
Other - Org Name:KEARNY MESA CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBBEL
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:858-278-8121
Mailing Address - Street 1:7675 FAMILY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5304
Mailing Address - Country:US
Mailing Address - Phone:858-278-8121
Mailing Address - Fax:858-278-8177
Practice Address - Street 1:7675 FAMILY CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5304
Practice Address - Country:US
Practice Address - Phone:858-278-8121
Practice Address - Fax:858-278-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05286FMedicaid
CAZZT05286FMedicaid