Healthcare Provider Details

I. General information

NPI: 1770616591
Provider Name (Legal Business Name): SUNSET VISTA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 N FOWLER AVE
SILVER CITY NM
88061-7202
US

IV. Provider business mailing address

3650 N FOWLER AVE
SILVER CITY NM
88061-7202
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-9095
  • Fax: 575-538-0035
Mailing address:
  • Phone: 575-538-9095
  • Fax: 575-538-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5563
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ALTON RAY SIRCY
Title or Position: VICE PRESIDENT
Credential: LPCC
Phone: 505-538-9095