Healthcare Provider Details

I. General information

NPI: 1437574894
Provider Name (Legal Business Name): VISTA CARE HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10949 BURNET AVE
MISSION HILLS CA
91345-1505
US

IV. Provider business mailing address

10949 BURNET AVE
MISSION HILLS CA
91345-1505
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-4999
  • Fax: 818-361-1666
Mailing address:
  • Phone: 818-361-4999
  • Fax: 818-361-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550002566
License Number StateCA

VIII. Authorized Official

Name: MISS ELIZA MARTIROSYAN
Title or Position: PRESIDENT
Credential:
Phone: 626-926-4303