Healthcare Provider Details

I. General information

NPI: 1619193729
Provider Name (Legal Business Name): LINDA VISTA MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7675 FAMILY CIR
SAN DIEGO CA
92111-5304
US

IV. Provider business mailing address

7675 FAMILY CIR
SAN DIEGO CA
92111-5304
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-8121
  • Fax: 858-278-8177
Mailing address:
  • Phone: 858-278-8121
  • Fax: 858-278-8177

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: MRS. CAROLYN HEBBEL
Title or Position: BUSINESS OFFICE MANAGER
Credential: BA
Phone: 858-278-8121