Healthcare Provider Details

I. General information

NPI: 1013623073
Provider Name (Legal Business Name): VISTA LA MESA SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 MARENGO AVE
LA MESA CA
91942-2408
US

IV. Provider business mailing address

100 N BARRANCA ST STE 200
WEST COVINA CA
91791-1651
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-0281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES BENDER
Title or Position: VICE PRESIDENT/DIRECTOR
Credential:
Phone: 310-430-2944