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General NPI Number Information
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NPI Number | 1770616591
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Entity Type | Organization
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Legal Business Name | SUNSET VISTA, INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 3650 N FOWLER AVE
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City | SILVER CITY
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State | NM
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Zip | 88061-7202
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Country | US
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Telephone | 575-538-9095
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Fax | 575-538-0035
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Provider Business Mailing Address
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Address Line | 3650 N FOWLER AVE
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City | SILVER CITY
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State | NM
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Zip | 88061-7202
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Country | US
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Telephone | 575-538-9095
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Fax | 575-538-0035
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. ALTON RAY SIRCY
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Credential | LPCC
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Telephone | 505-538-9095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5563
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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