Healthcare Provider Details

I. General information

NPI: 1750486379
Provider Name (Legal Business Name): RANCHO VISTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 E BOBIER DR
VISTA CA
92084-3806
US

IV. Provider business mailing address

9619 CHESAPEAKE DR SUITE 103
SAN DIEGO CA
92123-1368
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-1480
  • Fax: 760-941-5981
Mailing address:
  • Phone: 858-565-4424
  • Fax: 858-565-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: B. RENEE BARNARD
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 858-565-4424