Provider Demographics
NPI:1710212972
Name:VISTA OAKS SCC, LLC
Entity Type:Organization
Organization Name:VISTA OAKS SCC, LLC
Other - Org Name:VISTA OAKS OF LAKEWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-252-7600
Mailing Address - Street 1:2828 N HARWOOD ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1512
Mailing Address - Country:US
Mailing Address - Phone:214-252-7600
Mailing Address - Fax:214-252-7599
Practice Address - Street 1:1604 LOHMANS CROSSING RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-5198
Practice Address - Country:US
Practice Address - Phone:512-261-6653
Practice Address - Fax:512-261-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility