MEDICARE: NEW VISTA HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	910000018	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023005683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISTA HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	1516 SAWTELLE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3207
Country	:	US
Telephone Number	:	310-477-5501
Fax Number	:	310-473-8363

Provider Business Practice Location Address
First Line	:	1516 SAWTELLE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3207
Country	:	US
Telephone Number	:	310-477-5501
Fax Number	:	310-473-8363

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MARIE LOPEZ DEE
Credential	:	NHA
Telephone Number	:	310-477-5501

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	10/27/2011

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