AVISTA SENIOR LIVING VITA BELLA LLC NPI 1902185994

NPI Information

NPI: 1902185994
Provider Name: AVISTA SENIOR LIVING VITA BELLA, LLC
Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

CLIA Number: 03D2199739

Address:
248 N MACDONALD
MESA, AZ
ZIP 85201
Phone: (480) 964-6685
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AVISTA SENIOR LIVING VITA BELLA, LLC is a health service clinic center in Mesa, AZ. AVISTA SENIOR LIVING VITA BELLA, LLC NPI is 1902185994. The provider is registered as an organization entity type.

The provider's business location address is:

248 N MACDONALD
MESA, AZ
ZIP 85201-651
Phone: (480) 964-6685

The provider's authorized official is Kristopher L Woolley .
The authorized official title is Managing Member and has the following contact phone number (602) 628-5900.

The CLIA number assigned to this NPI record is 03D2199739 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/9/2011 and was last updated on 8/9/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service		ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	AL8507C	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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