Healthcare Provider Details

I. General information

NPI: 1881932424
Provider Name (Legal Business Name): NEW VISTA PAC OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 SAWTELLE BLVD
LOS ANGELES CA
90025-3207
US

IV. Provider business mailing address

4250 PENNSYLVANIA AVE STE 107
LA CRESCENTA CA
91214-3369
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-5501
  • Fax: 310-473-8363
Mailing address:
  • Phone: 818-273-8900
  • Fax: 818-273-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELYN CADABES
Title or Position: EXECUTIVE VP TO THE PRESIDENT
Credential:
Phone: 818-391-6720