Provider Demographics
NPI:1801016688
Name:SUNNY VISTA LIVING CENTER
Entity Type:Organization
Organization Name:SUNNY VISTA LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DENBRABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-974-3900
Mailing Address - Street 1:2445 E CACHE LA POUDRE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4812
Mailing Address - Country:US
Mailing Address - Phone:719-471-8700
Mailing Address - Fax:719-471-4352
Practice Address - Street 1:2445 E CACHE LA POUDRE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4812
Practice Address - Country:US
Practice Address - Phone:719-471-8700
Practice Address - Fax:719-471-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0094314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05654025Medicaid
CO065254Medicare ID - Type UnspecifiedLEGACY OSCAR NUMBER