Organization
MOUNTAIN VISTA MANOR CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUBEN BUGARIN BARRANCO (VICE PRESIDENT)
(480) 467-9055
Entity
Organization
Contact information
Practice address
1246 N 86TH PL, MESA, AZ 85207-4133
(480) 656-8851
Mailing address
1246 N 86TH PL, MESA, AZ 85207
(480) 656-8851
(480) 668-3612
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL8240H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
588277
AHCCS
AZ
Enumeration date
07/08/2011
Last updated
07/08/2011
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