MEDICARE: HILLSIDE VISTA SENIOR LIVING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1669305165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSIDE VISTA SENIOR LIVING INC

Provider Business Mailing Address
First Line	:	10808 AVENIDA CATHERINA
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1206
Country	:	US
Telephone Number	:	619-368-7868
Fax Number	:

Provider Business Practice Location Address
First Line	:	10808 AVENIDA CATHERINA
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1206
Country	:	US
Telephone Number	:	619-368-7868
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/LICENSEE
Name	:	ELAINE LOPEZ
Credential	:
Telephone Number	:	619-368-7868

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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