Organization
MIRA VISTA CORPORATION
Active
Other names
Mira Vista Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES SCOTT HALE (ADMINISTRATOR)
(360) 424-1320
Entity
Organization
Contact information
Practice address
300 S 18TH ST, MOUNT VERNON, WA 98274-4661
(360) 424-1320
(360) 848-1948
Mailing address
300 S 18TH ST, MOUNT VERNON, WA 98274-4661
(360) 424-1320
(360) 848-1948
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
957
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4195707
—
WA
Enumeration date
12/26/2006
Last updated
08/22/2020
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