Provider Demographics
NPI:1548451784
Name:NEW VISTA HEALTH SERVICE
Entity type:Organization
Organization Name:NEW VISTA HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-445-7037
Mailing Address - Street 1:501 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5527
Mailing Address - Country:US
Mailing Address - Phone:909-626-0117
Mailing Address - Fax:909-625-1654
Practice Address - Street 1:501 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5527
Practice Address - Country:US
Practice Address - Phone:909-626-0117
Practice Address - Fax:909-625-1654
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW VISTA HEALTH SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARCF00021FMedicaid