Mira Vista Corporation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

957 Issued in WA

Legal business name

MIRA VISTA CORPORATION

Practice address

300 S 18TH St
Mount Vernon, WA 98274-4661

Phone

(360) 424-1320

Fax

(360) 848-1948

NPI assigned

Dec 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. James Scott Hale

Title

Administrator

Phone

(360) 424-1320

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mira Vista Care Center Doing business as

Locations

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437214970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S 18TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744661",
            "telephone_number": "360-424-1320",
            "fax_number": "360-848-1948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 18TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744661",
            "telephone_number": "360-424-1320",
            "fax_number": "360-848-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRA VISTA CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "360-424-1320",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4195707",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mira Vista Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Ann Mills, M.P.T.
• Karl Mincin, B.S.
• Courtney S Miner
• Elisa L Minerich, ND
• Rajveer Singh Minhas, O.D.
• Sandra J Miracle, PT
• Heidi Mitchell-Sanchez, RN
• Brandy Mitchell
• Jeffrey T Mitchell, P.A.
• Howard M Mizuta, DDS

• Skilled Nursing Facility in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.