Provider Demographics
NPI:1245079052
Name:VISTA COVE AT RANCHO MIRAGE
Entity type:Organization
Organization Name:VISTA COVE AT RANCHO MIRAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:POYFAIR
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:760-218-6724
Mailing Address - Street 1:70201 MIRAGE COVE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2906
Mailing Address - Country:US
Mailing Address - Phone:760-324-4604
Mailing Address - Fax:760-318-4370
Practice Address - Street 1:70201 MIRAGE COVE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2906
Practice Address - Country:US
Practice Address - Phone:760-324-4604
Practice Address - Fax:760-318-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility