Healthcare Provider Details

I. General information

NPI: 1275266140
Provider Name (Legal Business Name): VISTA AT SIMI VALLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 ERRINGER RD
SIMI VALLEY CA
93065-4502
US

IV. Provider business mailing address

1236 ERRINGER RD
SIMI VALLEY CA
93065-4502
US

V. Phone/Fax

Practice location:
  • Phone: 805-351-8802
  • Fax:
Mailing address:
  • Phone: 805-351-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ZAHARONI
Title or Position: OWNER
Credential:
Phone: 310-617-6718