Healthcare Provider Details

I. General information

NPI: 1336082296
Provider Name (Legal Business Name): VISTA GRAND CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 VISTA GRANDE DR NW
ALBUQUERQUE NM
87120-1125
US

IV. Provider business mailing address

1500 MONTERREY RD NE
RIO RANCHO NM
87144-1584
US

V. Phone/Fax

Practice location:
  • Phone: 505-835-3834
  • Fax: 877-497-3444
Mailing address:
  • Phone: 505-835-3834
  • Fax: 877-497-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TRANON BASHTON
Title or Position: CEO
Credential:
Phone: 505-835-3834