Healthcare Provider Details

I. General information

NPI: 1033112842
Provider Name (Legal Business Name): VISTA CONTINUING CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 VISTA RD
PASADENA TX
77504-2118
US

IV. Provider business mailing address

4300 VISTA RD
PASADENA TX
77504-2118
US

V. Phone/Fax

Practice location:
  • Phone: 713-946-6787
  • Fax: 713-946-1337
Mailing address:
  • Phone: 713-946-6787
  • Fax: 713-946-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number111815
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHEN COHEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 903-569-9023