1033112842 NPI number — VISTA CONTINUING CARE CENTER INC

Table of content: (NPI 1033112842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033112842 NPI number — VISTA CONTINUING CARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISTA CONTINUING CARE CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VISTA CONTINUING CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033112842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 VISTA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-946-6787
Provider Business Mailing Address Fax Number:
713-946-1337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 VISTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-946-6787
Provider Business Practice Location Address Fax Number:
713-946-1337
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
903-569-9023

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  111815 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000512001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021984201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".