Healthcare Provider Details

I. General information

NPI: 1780005256
Provider Name (Legal Business Name): VISTA COVE CARE CENTER AT LONG BEACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CEDAR AVE
LONG BEACH CA
90807-4422
US

IV. Provider business mailing address

3401 CEDAR AVE
LONG BEACH CA
90807-4422
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-4461
  • Fax: 562-426-4972
Mailing address:
  • Phone: 562-426-4461
  • Fax: 562-426-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BONAPARTE H LIU
Title or Position: TREASURER
Credential:
Phone: 949-205-4060