Healthcare Provider Details

I. General information

NPI: 1831382415
Provider Name (Legal Business Name): RANCHO VISTA OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 01/13/2009
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

9510 ORMSBY STATION RD SUITE 101
LOUISVILLE KY
40223-4081
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-1480
  • Fax: 760-941-5981
Mailing address:
  • Phone: 502-753-6004
  • Fax: 502-753-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080000235
License Number StateCA

VIII. Authorized Official

Name: MS. ROBIN L. BARBER
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 502-753-6004