Broadwater Bella Vista Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000113 Issued in CA

Legal business name

BROADWATER BELLA VISTA CARE CENTER, LLC

Practice address

933 E Deodar St
Ontario, CA 91764-1309

Phone

(909) 985-2731

Fax

(909) 985-1414

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Douglas Easton

Title

Manager

Phone

(818) 368-1862

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bella Vista Healthcare Center Doing business as

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1679616528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 E DEODAR ST",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917641309",
            "telephone_number": "909-985-2731",
            "fax_number": "909-985-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 E DEODAR ST",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917641309",
            "telephone_number": "909-985-2731",
            "fax_number": "909-985-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWATER BELLA VISTA CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "EASTON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-368-1862"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "240000113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679616528",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bella Vista Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Ontario, CA
• Providers in Ontario, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.