Provider Demographics
NPI:1942206305
Name:VISTA PACIFICA ENTERPRISES
Entity Type:Organization
Organization Name:VISTA PACIFICA ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:B
Authorized Official - Last Name:JUMONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-682-4833
Mailing Address - Street 1:3674 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-1948
Mailing Address - Country:US
Mailing Address - Phone:951-682-4833
Mailing Address - Fax:951-682-1503
Practice Address - Street 1:3662 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-1948
Practice Address - Country:US
Practice Address - Phone:951-682-4833
Practice Address - Fax:951-274-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility