Vista South Assisting Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALH5881 Issued in AZ

Legal business name

VISTA SOUTH ASSISTING LIVING

Practice address

1010 E Southern Ave BLDG 2
Phoenix, AZ 85040-5108

Phone

(602) 435-3808

Fax

(602) 276-1854

NPI assigned

Feb 9, 2007

Last updated

Sep 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kenneth Ray Thomas

Title

Owner

Phone

(602) 435-3808

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vista South Assisted Living Other name

Locations

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1194866277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 E SOUTHERN AVE BLDG 2",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850405108",
            "telephone_number": "602-435-3808",
            "fax_number": "602-276-1854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 E SOUTHERN AVE BLDG 2",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850405108",
            "telephone_number": "602-435-3808",
            "fax_number": "602-276-1854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA SOUTH ASSISTING LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-435-3808"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "ALH5881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174413",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vista South Assisted Living",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.