1386631331 NPI number — VISTA HILLS HEALTH CARE CENTER LP

Table of content: (NPI 1386631331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386631331 NPI number — VISTA HILLS HEALTH CARE CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISTA HILLS HEALTH CARE CENTER LP
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 HILLS HEALTH 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:
1386631331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 DRYDEN ROAD
Provider Second Line Business Mailing Address:
SUITE 2000
Provider Business Mailing Address City Name:
DRESHER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-441-7700
Provider Business Mailing Address Fax Number:
215-441-4255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1599 LOMALAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79935-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-593-1131
Provider Business Practice Location Address Fax Number:
915-593-2938
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LICARI
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT OF GENERAL PARTNER
Authorized Official Telephone Number:
215-441-7700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  109569 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , with the licence number: 116883 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 116883 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 005086 . This is a "VENDOR # STATE OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com