Healthcare Provider Details

I. General information

NPI: 1093223729
Provider Name (Legal Business Name): CANYON VISTA POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20554 ROSCOE BLVD
CANOGA PARK CA
91306-1746
US

IV. Provider business mailing address

107 W LEMON AVE
MONROVIA CA
91016-2809
US

V. Phone/Fax

Practice location:
  • Phone: 818-341-9800
  • Fax: 818-341-1925
Mailing address:
  • Phone: 626-346-0300
  • Fax: 626-737-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000041
License Number StateCA

VIII. Authorized Official

Name: CRYSTAL SOLORZANO
Title or Position: MANAGER
Credential:
Phone: 626-346-0300