Healthcare Provider Details

I. General information

NPI: 1366802696
Provider Name (Legal Business Name): VISTA POST ACUTE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 E BOBIER DR
VISTA CA
92084-3026
US

IV. Provider business mailing address

247 E BOBIER DR
VISTA CA
92084-3026
US

V. Phone/Fax

Practice location:
  • Phone: 760-945-3033
  • Fax: 760-724-3169
Mailing address:
  • Phone: 760-945-3033
  • Fax: 760-724-3169

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: DOV E JACOBS
Title or Position: MANAGER
Credential:
Phone: 760-724-3169