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NPI Code Detail

MEDICARE: BUENA VISTA INC

MEDICARE: BUENA VISTA 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
1310400000XAssisted Living FacilityBH 1023WA
2314000000XSkilled Nursing FacilityNH 1244WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2127682OTHERWASSPS#

General Provider Information

NPI Number : 1487651121
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUENA VISTA INC
Provider Business Mailing Address
First Line : 151 BUENA VISTA DR
Second Line :
City : COLVILLE
State : WA
Zip : 99114-8676
Country : US
Telephone Number : 509-684-4539
Fax Number : 509-684-6013
Provider Business Practice Location Address
First Line : 151 BUENA VISTA DR
Second Line :
City : COLVILLE
State : WA
Zip : 99114-8676
Country : US
Telephone Number : 509-684-4539
Fax Number : 509-685-0582
Authorized Official
Title or Position : ADMINISTRATOR
Name : LORRI CARTER
Credential :
Telephone Number : 509-684-4539
Provider Enumeration Date : 07/07/2005
Last Update Date : 03/11/2014

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Directions to “BUENA VISTA INC ” Practice Location

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