Healthcare Provider Details

I. General information

NPI: 1043207384
Provider Name (Legal Business Name): BELLA VISTA OPERATING COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 E DEODAR ST
ONTARIO CA
91764-1309
US

IV. Provider business mailing address

933 E DEODAR ST
ONTARIO CA
91764-1309
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-2731
  • Fax: 909-985-1414
Mailing address:
  • Phone: 818-368-1862
  • Fax: 818-368-8079

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: MR. ROBERT REISS
Title or Position: MANAGER
Credential:
Phone: 818-368-5200