Provider Demographics
NPI:1780005256
Name:VISTA COVE CARE CENTER AT LONG BEACH, INC.
Entity Type:Organization
Organization Name:VISTA COVE CARE CENTER AT LONG BEACH, INC.
Other - Org Name:VISTA COVE CARE CENTER AT LONG BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:BONAPARTE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-205-4060
Mailing Address - Street 1:3401 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4422
Mailing Address - Country:US
Mailing Address - Phone:562-426-4461
Mailing Address - Fax:562-426-4972
Practice Address - Street 1:3401 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4422
Practice Address - Country:US
Practice Address - Phone:562-426-4461
Practice Address - Fax:562-426-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2014-06-19
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
CA055364Medicare Oscar/Certification
CAZ055364Medicare PIN