Healthcare Provider Details

I. General information

NPI: 1669305165
Provider Name (Legal Business Name): HILLSIDE VISTA SENIOR LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10808 AVENIDA CATHERINA
SPRING VALLEY CA
91978-1206
US

IV. Provider business mailing address

10808 AVENIDA CATHERINA
SPRING VALLEY CA
91978-1206
US

V. Phone/Fax

Practice location:
  • Phone: 619-368-7868
  • Fax:
Mailing address:
  • Phone: 619-368-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ELAINE LOPEZ
Title or Position: ADMINISTRATOR/LICENSEE
Credential:
Phone: 619-368-7868