Healthcare Provider Details

I. General information

NPI: 1861302879
Provider Name (Legal Business Name): VAN VISTA PLAZA LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 13TH ST
VANCOUVER WA
98660-2876
US

IV. Provider business mailing address

410 W 13TH ST
VANCOUVER WA
98660-2876
US

V. Phone/Fax

Practice location:
  • Phone: 360-750-4665
  • Fax: 360-750-6740
Mailing address:
  • Phone: 360-750-4665
  • Fax: 360-750-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SHEENA HOPE BAH
Title or Position: EXECUTIVE DIRECTOR
Credential: LPN
Phone: 360-750-4665