MEDICARE: VISTA DEL SOL 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	310400000X	Assisted Living Facility	191601231	CA

General Provider Information

NPI Number	:	1467834085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA DEL SOL HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	11620 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5916
Country	:	US
Telephone Number	:	310-390-9045
Fax Number	:	310-391-7677

Provider Business Practice Location Address
First Line	:	4323 COOLIDGE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5905
Country	:	US
Telephone Number	:	310-390-9045
Fax Number	:	310-391-7677

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES R PREIMESBERGER
Credential	:
Telephone Number	:	310-390-9045

Provider Enumeration Date	:	06/19/2015
Last Update Date	:	06/19/2015

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