NPIMap

Organization Active NPI

Vista Assisted Living

  • Assisted Living Facility
  • St Maries, ID
National Provider Identifier
1063723872
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
VISTA ASSISTED LIVING
Practice address
820 Elm Dr
St Maries, ID 83861-2119
Phone
(208) 245-4576
Fax
(208) 245-2138
NPI assigned
Jun 25, 2010
Last updated
Apr 9, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
VALLEY VISTA CARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kasey Wilks
Title
Director of Corporate Compliance
Phone
(208) 245-4576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU Primary

Addresses

Primary practice location

820 Elm Dr
St Maries, ID 83861-2119

Mailing address

243 N 300 E
Rupert, ID 83350-9491
Phone (208) 436-3332

Other identifiers 1

IdentifierTypeStateIssuer
M0026110-006MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Antelope Creek Assisted Living20 organizations share this tax ID, including this one
Part of
Antelope Creek Assisted Living

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1063723872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 N 300 E",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833509491",
            "telephone_number": "208-436-3332",
            "fax_number": "208-436-1289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 ELM DR",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838612119",
            "telephone_number": "208-245-4576",
            "fax_number": "208-245-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA ASSISTED LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VALLEY VISTA CARE CORPORATION",
        "enumeration_date": "2010-06-25",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "WILKS",
        "authorized_official_first_name": "KASEY",
        "authorized_official_title_or_position": "DIRECTOR OF CORPORATE COMPLIANCE",
        "authorized_official_telephone_number": "208-245-4576"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M0026110-006",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Maries, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.