Extended Care Portfolio California Tenant LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EXTENDED CARE PORTFOLIO CALIFORNIA TENANT LLC

Doing business as

Sierra Vista Independent and Assisted Living

Practice address

13815 Rodeo Drive
Victorville, CA 92395

Phone

(760) 243-2271

Fax

(760) 243-1711

NPI assigned

Jul 19, 2023

Last updated

Jul 19, 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

Deepak Israni

Title

General Manager

Phone

(619) 296-9000

Specialties & licenses 1

Addresses

Other names 1

• Sierra Vista Independent and Assisted Living Doing business as

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1437839008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13815 RODEO DRIVE",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "92395",
            "telephone_number": "760-243-2271",
            "fax_number": "760-243-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13815 RODEO DRIVE",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "92395",
            "telephone_number": "760-243-2271",
            "fax_number": "760-243-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED CARE PORTFOLIO CALIFORNIA TENANT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A",
        "authorized_official_last_name": "ISRANI",
        "authorized_official_first_name": "DEEPAK",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "619-296-9000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Vista Independent and Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Victorville, CA
• Providers in Victorville, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.