Peoria Vista Care LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PEORIA VISTA CARE LLC

Doing business as

Peoria Vista Care LLC

Practice address

10430 W Royal Palm Rd
Peoria, AZ 85345-7537

Phone

(623) 440-5391

NPI assigned

Jan 19, 2022

Organization subpart

No

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

Authorized official

Name

Stevan PolusNPI 1588413231

Title

Owner

Phone

(602) 481-8746

Specialties & licenses 1

Addresses

Other names 1

• Peoria Vista Care LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stevan A Polus

  • Assisted Living Facility
  • Peoria, AZ
  • NPI 1588413231
  NPD Authorized official

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

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1912659178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10430 W ROYAL PALM RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853457537",
            "telephone_number": "623-440-5391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10430 W ROYAL PALM RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853457537",
            "telephone_number": "623-440-5391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA VISTA CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-19",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "POLUS",
        "authorized_official_first_name": "STEVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-481-8746"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peoria Vista Care LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Alejandro Jose Peralta Ortega, FNP-C
• Audrey Percival, PA-C
• Melesande Marie Perera, MS OTR

• Assisted Living Facility in Peoria, AZ
• Providers in Peoria, 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 Jun 21, 2024; 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.