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General NPI Number Information
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NPI Number | 1487651121
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Entity Type | Organization
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Legal Business Name | BUENA VISTA INC
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 151 BUENA VISTA DR
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City | COLVILLE
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State | WA
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Zip | 99114-8676
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Country | US
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Telephone | 509-684-4539
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Fax | 509-685-0582
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Provider Business Mailing Address
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Address Line | 151 BUENA VISTA DR
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City | COLVILLE
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State | WA
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Zip | 99114-8676
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Country | US
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Telephone | 509-684-4539
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Fax | 509-684-6013
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LORRI CARTER
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Credential |
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Telephone | 509-684-4539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | BH 1023
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH 1244
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License Number State | WA
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