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NPI Code Detail

MEDICARE: 4300 VISTA RD OPCO LLC

MEDICARE: 4300 VISTA RD OPCO LLC
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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1417845215
Entity Type Code : Organization
Provider Name (Legal Business Name) : 4300 VISTA RD OPCO LLC
Provider Business Mailing Address
First Line : 4300 VISTA RD
Second Line :
City : PASADENA
State : TX
Zip : 77504-2118
Country : US
Telephone Number : 713-946-6787
Fax Number : 713-946-0352
Provider Business Practice Location Address
First Line : 4300 VISTA RD
Second Line :
City : PASADENA
State : TX
Zip : 77504-2118
Country : US
Telephone Number : 713-946-6787
Fax Number : 713-946-0352
Authorized Official
Title or Position : MANAGER
Name : NOCHUM FREUND
Credential :
Telephone Number : 732-719-5098
Provider Enumeration Date : 06/27/2025
Last Update Date : 06/27/2025

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