Healthcare Provider Details

I. General information

NPI: 1770083990
Provider Name (Legal Business Name): ROYAL VISTA CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

55 S RAYMOND AVE STE 105
ALHAMBRA CA
91801-7101
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-5365
  • Fax:
Mailing address:
  • Phone: 626-248-3350
  • Fax:

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: DAVID ROGER ALLEN
Title or Position: VICE PRESIDEN OF FINANCE
Credential:
Phone: 626-248-3350