Healthcare Provider Details

I. General information

NPI: 1255656781
Provider Name (Legal Business Name): VISTA COVE CARE CENTER AT SANTA PAULA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2010
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MARCH ST
SANTA PAULA CA
93060-2512
US

IV. Provider business mailing address

5 SAN JOAQUIN PLZ SUITE 350
NEWPORT BEACH CA
92660-5923
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-7134
  • Fax: 805-933-0055
Mailing address:
  • Phone: 949-205-4060
  • Fax: 949-205-4061

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. BONAPARTE LIU
Title or Position: TREASURER
Credential:
Phone: 949-205-4060