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General NPI Number Information
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NPI Number | 1417845215
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Entity Type | Organization
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Legal Business Name | 4300 VISTA RD OPCO LLC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 4300 VISTA RD
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City | PASADENA
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State | TX
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Zip | 77504-2118
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Country | US
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Telephone | 713-946-6787
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Fax | 713-946-0352
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Provider Business Mailing Address
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Address Line | 4300 VISTA RD
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City | PASADENA
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State | TX
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Zip | 77504-2118
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Country | US
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Telephone | 713-946-6787
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Fax | 713-946-0352
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Authorized Official
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Title or Position | MANAGER
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Name | NOCHUM FREUND
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Credential |
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Telephone | 732-719-5098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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