Healthcare Provider Details

I. General information

NPI: 1982486981
Provider Name (Legal Business Name): AVISTA LIVING AND CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12667 YORKSHIRE DR
APPLE VALLEY CA
92308-2709
US

IV. Provider business mailing address

12667 YORKSHIRE DR
APPLE VALLEY CA
92308-2709
US

V. Phone/Fax

Practice location:
  • Phone: 760-605-4674
  • Fax:
Mailing address:
  • Phone: 760-605-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ADETUTU ESTHER LALA
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 760-605-4674