Healthcare Provider Details

I. General information

NPI: 1659458271
Provider Name (Legal Business Name): VISTA COVE CARE CENTER AT SAN GABRIEL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W SANTA ANITA ST
SAN GABRIEL CA
91776-1018
US

IV. Provider business mailing address

909 W SANTA ANITA ST
SAN GABRIEL CA
91776-1018
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-5365
  • Fax: 626-289-9503
Mailing address:
  • Phone: 626-289-5365
  • Fax: 626-289-9503

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 LIU
Title or Position: TREASURER
Credential:
Phone: 626-644-4664