# BROADWATER BELLA VISTA CARE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bella Vista Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679616528
- **Authorized official:** DOUGLAS EASTON (MANAGER)
- **Authorized official phone:** (818) 368-1862

## Contact information

- **Practice address:** 933 E DEODAR ST, ONTARIO, CA 91764-1309
- **Practice address phone:** (909) 985-2731
- **Practice address fax:** (909) 985-1414
- **Mailing address:** 933 E DEODAR ST, ONTARIO, CA 91764-1309
- **Mailing address phone:** (909) 985-2731
- **Mailing address fax:** (909) 985-1414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 240000113 | CA | Yes |

## Other

- **Enumeration date:** 02/14/2007
- **Last updated:** 06/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1679616528 | — | CA |