Healthcare Provider Details

I. General information

NPI: 1972217131
Provider Name (Legal Business Name): BUENA VISTA SNF OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 BUENA VISTA DR
COLVILLE WA
99114-8676
US

IV. Provider business mailing address

1777 AVENUE OF THE STATES STE 102
LAKEWOOD NJ
08701-4779
US

V. Phone/Fax

Practice location:
  • Phone: 509-684-4539
  • Fax:
Mailing address:
  • Phone: 732-366-8300
  • Fax: 732-523-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: YITZCHOK YENOWITZ
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 323-333-0910