Provider Demographics
NPI:1770616591
Name:SUNSET VISTA, INC
Entity type:Organization
Organization Name:SUNSET VISTA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SIRCY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-538-9095
Mailing Address - Street 1:3650 N FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7202
Mailing Address - Country:US
Mailing Address - Phone:575-538-9095
Mailing Address - Fax:575-538-0035
Practice Address - Street 1:3650 N FOWLER AVE
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7202
Practice Address - Country:US
Practice Address - Phone:575-538-9095
Practice Address - Fax:575-538-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5563174400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0000D3756Medicaid