MEDICARE: NEW VISTA PAC OPERATOR, 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1881932424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISTA PAC OPERATOR, LLC

Provider Business Mailing Address
First Line	:	4250 PENNSYLVANIA AVE STE 107
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3369
Country	:	US
Telephone Number	:	818-273-8900
Fax Number	:	818-273-8910

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 VP TO THE PRESIDENT
Name	:	MELYN CADABES
Credential	:
Telephone Number	:	818-391-6720

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	07/17/2024

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