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General NPI Number Information
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NPI Number | 1740858679
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Entity Type | Organization
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Legal Business Name | ALTA VISTA CONGREGATE LIVING, LLC.
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 13880 PROCTOR AVE
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City | LA PUENTE
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State | CA
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Zip | 91746-2529
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Country | US
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Telephone | 626-373-7619
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Fax | 888-385-1958
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Provider Business Mailing Address
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Address Line | 13880 PROCTOR AVE
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City | LA PUENTE
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State | CA
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Zip | 91746-2529
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Country | US
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Telephone | 626-373-7619
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Fax | 888-385-1958
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NICOLE STINSON
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Credential |
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Telephone | 626-373-7619
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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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