Basic Information
| Provider Information | |||||||||
| NPI: | 1912189812 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BHC VISTA OPERATIONS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VISTA HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 NORTH REAL ROAD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613950803 | ||||||||
| FaxNumber: | 6613273147 | ||||||||
| Practice Location | |||||||||
| Address1: | 247 E BOBIER DR | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920843026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607243169 | ||||||||
| FaxNumber: | 7607243169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 05/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | ANDRIOTTI | ||||||||
| AuthorizedOfficialFirstName: | LOU | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6164646122 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LIFEHOUSE HEALTH SERVICES, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | APPROVAL PENDING | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.