Provider Demographics
NPI:1669039699
Name:PARK VISTA POST ACUTE LLC
Entity Type:Organization
Organization Name:PARK VISTA POST ACUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLORZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-346-0300
Mailing Address - Street 1:107 W LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2809
Mailing Address - Country:US
Mailing Address - Phone:626-658-7344
Mailing Address - Fax:
Practice Address - Street 1:980 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-3814
Practice Address - Country:US
Practice Address - Phone:951-654-9347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055598OtherMEDICARE PTAN
CAZZT05598HMedicaid