Healthcare Provider Details

I. General information

NPI: 1710382692
Provider Name (Legal Business Name): VISTA PARK SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 S BYRON RD
WICHITA KS
67209-1812
US

IV. Provider business mailing address

7931 W UNIVERSITY ST
WICHITA KS
67209-2031
US

V. Phone/Fax

Practice location:
  • Phone: 316-305-3412
  • Fax: 316-425-8181
Mailing address:
  • Phone: 316-305-3412
  • Fax: 316-425-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberB087207
License Number StateKS

VIII. Authorized Official

Name: MS. ELBA ABREU
Title or Position: OWNER
Credential:
Phone: 316-305-3412