Provider Demographics
NPI:1881025898
Name:VISTA COVE AT SAN GABRIEL, INC.
Entity Type:Organization
Organization Name:VISTA COVE AT SAN GABRIEL, INC.
Other - Org Name:
Other - Org Type:
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 1:5 SAN JOAQUIN PLZ STE 350
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5969
Mailing Address - Country:US
Mailing Address - Phone:949-205-4052
Mailing Address - Fax:949-205-4053
Practice Address - Street 1:901 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:626-289-8889
Practice Address - Fax:626-289-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197606796310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility