Provider Demographics
NPI:1659458271
Name:VISTA COVE CARE CENTER AT SAN GABRIEL, INC.
Entity Type:Organization
Organization Name:VISTA COVE CARE CENTER AT SAN GABRIEL, INC.
Other - Org Name:VISTA COVE CARE CENTER AT SAN GABRIEL
Other - Org Type:Doing Business As
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:626-644-4664
Mailing Address - Street 1:909 W SANTA ANITA ST
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1018
Mailing Address - Country:US
Mailing Address - Phone:626-289-5365
Mailing Address - Fax:626-289-9503
Practice Address - Street 1:909 W SANTA ANITA ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1018
Practice Address - Country:US
Practice Address - Phone:626-289-5365
Practice Address - Fax:626-289-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility