# ALTA VISTA CONGREGATE LIVING, LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740858679
- **Authorized official:** NICOLE STINSON (VICE PRESIDENT)
- **Authorized official phone:** (626) 373-7619

## Contact information

- **Practice address:** 13880 PROCTOR AVE, LA PUENTE, CA 91746-2529
- **Practice address phone:** (626) 373-7619
- **Practice address fax:** (888) 385-1958
- **Mailing address:** 13880 PROCTOR AVE, LA PUENTE, CA 91746-2529
- **Mailing address phone:** (626) 373-7619
- **Mailing address fax:** (888) 385-1958

## Taxonomy

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

## Other

- **Enumeration date:** 06/16/2021
- **Last updated:** 07/09/2021