Provider Demographics
NPI:1043207384
Name:BELLA VISTA OPERATING COMPANY INC
Entity type:Organization
Organization Name:BELLA VISTA OPERATING COMPANY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-368-5200
Mailing Address - Street 1:933 E DEODAR ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-1309
Mailing Address - Country:US
Mailing Address - Phone:818-368-1862
Mailing Address - Fax:818-368-8079
Practice Address - Street 1:933 E DEODAR ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-1309
Practice Address - Country:US
Practice Address - Phone:909-985-2731
Practice Address - Fax:909-985-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05693IMedicaid
CAZZT05693IMedicaid
CA4524840001Medicare NSC