Provider Demographics
NPI:1649510496
Name:RIO VISTA AFH
Entity type:Organization
Organization Name:RIO VISTA AFH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BELEN
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADULT CARE HOME
Authorized Official - Phone:360-253-6813
Mailing Address - Street 1:10106 SE FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3726
Mailing Address - Country:US
Mailing Address - Phone:360-253-6813
Mailing Address - Fax:360-253-8405
Practice Address - Street 1:10106 SE FRENCH RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3726
Practice Address - Country:US
Practice Address - Phone:360-253-6813
Practice Address - Fax:360-253-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613900313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility